Healthcare Provider Details

I. General information

NPI: 1366378119
Provider Name (Legal Business Name): KELSEY RELLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 VINE ST APT 502
DENVER CO
80206-2939
US

IV. Provider business mailing address

1211 VINE ST APT 502
DENVER CO
80206-2939
US

V. Phone/Fax

Practice location:
  • Phone: 858-869-5947
  • Fax:
Mailing address:
  • Phone: 858-869-5947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0022862
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: