Provider Demographics
NPI:1699155325
Name:KJELLSEN, KELSEY (LPC)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:KJELLSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 S POWER RD STE 120
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-6688
Mailing Address - Country:US
Mailing Address - Phone:605-695-9498
Mailing Address - Fax:
Practice Address - Street 1:2500 S POWER RD STE 120
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-6688
Practice Address - Country:US
Practice Address - Phone:970-510-6911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional