Healthcare Provider Details

I. General information

NPI: 1720733272
Provider Name (Legal Business Name): KELSEY JUNE HERMANN APCC, PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 GLOSTER WAY
SACRAMENTO CA
95834-2038
US

IV. Provider business mailing address

4004 GLOSTER WAY
SACRAMENTO CA
95834-2038
US

V. Phone/Fax

Practice location:
  • Phone: 916-928-5316
  • Fax:
Mailing address:
  • Phone: 916-928-5316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11519
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: