Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003209107 |
---|---|
Provider Name | Kelsey Gielen |
First Address | Petaluma, CA 94952-9606 |
Second Address | Petaluma, CA 94952-9606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2015 |
Last Update Date | 13/03/2015 |