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NPI Code Detail

MEDICARE: KELSEY BRIANNE MAYNARD BSW

MEDICARE: KELSEY BRIANNE MAYNARD BSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorWV

General Provider Information

NPI Number : 1407780513
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY BRIANNE MAYNARD BSW
Provider Business Mailing Address
First Line : 502 GUM ST APT 37
Second Line :
City : WILLIAMSON
State : WV
Zip : 25661-3041
Country : US
Telephone Number : 304-235-0026
Fax Number :
Provider Business Practice Location Address
First Line : 1609 W 3RD AVE
Second Line :
City : WILLIAMSON
State : WV
Zip : 25661-3006
Country : US
Telephone Number : 304-235-0026
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2026
Last Update Date : 06/12/2026

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