Provider Demographics
NPI:1124527262
Name:ALBERT, KELSEY JEAN (LPCC)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:JEAN
Last Name:ALBERT
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:JEAN
Other - Last Name:MCILVAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:434 EASTLAND RD
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-1217
Mailing Address - Country:US
Mailing Address - Phone:330-343-8171
Mailing Address - Fax:330-343-8439
Practice Address - Street 1:1433 5TH ST NW
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-1223
Practice Address - Country:US
Practice Address - Phone:330-343-8171
Practice Address - Fax:330-343-8439
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1700482101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0260983Medicaid
OHE.1700482OtherLICENSE