Healthcare Provider Details

I. General information

NPI: 1487812053
Provider Name (Legal Business Name): KELSEY OLBRICH MCNEILL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 VESTA RD
SALIDA CO
81201-9327
US

IV. Provider business mailing address

3225 INDEPENDENCE RD.
CANON CITY CO
81212
US

V. Phone/Fax

Practice location:
  • Phone: 719-539-6502
  • Fax:
Mailing address:
  • Phone: 719-275-2351
  • Fax: 719-269-9386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: