Healthcare Provider Details

I. General information

NPI: 1457444903
Provider Name (Legal Business Name): LINDA G. KELSEY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W BULLARD AVE STE. F2
CLOVIS CA
93612-7610
US

IV. Provider business mailing address

PO BOX 1751
CLOVIS CA
93613-1751
US

V. Phone/Fax

Practice location:
  • Phone: 559-960-7383
  • Fax: 559-298-3717
Mailing address:
  • Phone: 559-960-7383
  • Fax: 559-298-3717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY11100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: