Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1659733418 |
---|---|
Provider Name | Robert Kelsey |
First Address | Kennett, MO 63857 |
Second Address | Kennett, MO 63857 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2016 |
Last Update Date | 22/03/2016 |