Provider Demographics
NPI:1588387419
Name:KELICH, JEFFREY GLENN (MSED)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:GLENN
Last Name:KELICH
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10291 N MERIDIAN ST STE 310
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1083
Mailing Address - Country:US
Mailing Address - Phone:317-672-1970
Mailing Address - Fax:
Practice Address - Street 1:10291 N MERIDIAN ST STE 310
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46290-1083
Practice Address - Country:US
Practice Address - Phone:317-672-1970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health