Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2964 | KS |
NPI | 1003353657 |
---|---|
Provider Name | Kelsey Brush |
First Address | Overland Park, KS 66223-3919 |
Second Address | Kansas City, KS 66103-3125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2017 |
Last Update Date | 20/01/2017 |