Healthcare Provider Details

I. General information

NPI: 1255632279
Provider Name (Legal Business Name): ERICA KELSEY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W 10TH ST
INDIANAPOLIS IN
46202-4800
US

IV. Provider business mailing address

PO BOX 44994
INDIANAPOLIS IN
46244-0994
US

V. Phone/Fax

Practice location:
  • Phone: 601-466-9459
  • Fax:
Mailing address:
  • Phone: 317-274-4402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042596A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number20042596A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: