Provider Demographics
NPI:1992348817
Name:THEESFELD, KELSEY LYNN (LCSW-PIP, LAC, QMHP)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LYNN
Last Name:THEESFELD
Suffix:
Gender:F
Credentials:LCSW-PIP, LAC, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 W WILSON DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-7623
Mailing Address - Country:US
Mailing Address - Phone:507-302-3228
Mailing Address - Fax:
Practice Address - Street 1:5000 S MINNESOTA AVE STE 300
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2700
Practice Address - Country:US
Practice Address - Phone:507-302-3228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD19091829101YA0400X
SD60521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)