Provider Demographics
NPI:1699882449
Name:KELSO, ANIKA M (LCSW)
Entity type:Individual
Prefix:
First Name:ANIKA
Middle Name:M
Last Name:KELSO
Suffix:
Gender:
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 6623
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502-6623
Mailing Address - Country:US
Mailing Address - Phone:505-795-6868
Mailing Address - Fax:
Practice Address - Street 1:1418 LUISA ST STE 5A
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4091
Practice Address - Country:US
Practice Address - Phone:505-795-6868
Practice Address - Fax:505-926-0906
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-066991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM61424374Medicaid