Provider Demographics
NPI:1699868984
Name:KELSEY, MELANIE MARCIA (LCSW)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:MARCIA
Last Name:KELSEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1632
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-0125
Mailing Address - Country:US
Mailing Address - Phone:541-608-6850
Mailing Address - Fax:541-608-3880
Practice Address - Street 1:955 TOWN CENTRE DR
Practice Address - Street 2:SUITE A
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6188
Practice Address - Country:US
Practice Address - Phone:541-608-6850
Practice Address - Fax:541-608-3880
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL19851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR115483Medicare ID - Type Unspecified
ORP17176Medicare UPIN
ORR115483Medicare PIN