Kelly D Tucker Bernal, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2016042812 Issued in MO

Practice address

1103 Weber Rd
Farmington, MO 63640-3345

Phone

(573) 664-1629

Fax

(573) 431-6580

NPI assigned

Dec 16, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kelly Bernal Other name

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 1999

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southeast Missouri Behavioral Health Inc

  • Community/Behavioral Health Agency
  • Farmington, MO
  • NPI 1982875407
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785196800000",
    "number": "1760468375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844715",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641844715",
            "telephone_number": "417-761-5214",
            "fax_number": "417-761-5065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 WEBER RD",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636403345",
            "telephone_number": "573-664-1629",
            "fax_number": "573-431-6580"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24 Southtowne Dr",
            "address_purpose": "LOCATION",
            "city": "Potosi",
            "state": "MO",
            "postal_code": "636645729",
            "country_code": "US",
            "telephone_number": "573-438-6706",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TUCKER BERNAL",
        "first_name": "KELLY",
        "middle_name": "D",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-16",
        "last_updated": "2026-07-28",
        "certification_date": "2026-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2016042812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "BERNAL",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Cheryl Lynn Townsend, RN WHNP-BC
• Tradewinds Taxi & Shuttle Service LLC
• Alyssa Trautman
• Tricorex Inc
• True Care Home Health Equipment Sales and Service LLC
• Jeffery L Tupper I
• Keaton Turner
• Mackenzie Turner
• Macie Turntine, M.S., CF-SLP
• Upward Smiles,Inc

• Professional Counselor in Farmington, MO
• Providers in Farmington, MO by specialty
• Professional Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.