Provider Demographics
NPI:1083340814
Name:RAY, KELSEY MARIE (LCSW, CRADC)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:MARIE
Last Name:RAY
Suffix:
Gender:F
Credentials:LCSW, CRADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28590 S 1025 RD
Mailing Address - Street 2:
Mailing Address - City:BRONAUGH
Mailing Address - State:MO
Mailing Address - Zip Code:64728-7613
Mailing Address - Country:US
Mailing Address - Phone:816-560-1077
Mailing Address - Fax:
Practice Address - Street 1:805 N ORANGE ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:MO
Practice Address - Zip Code:64730-9382
Practice Address - Country:US
Practice Address - Phone:417-448-9247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240311191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2022028537Medicaid