Healthcare Provider Details

I. General information

NPI: 1710896584
Provider Name (Legal Business Name): KELSEY MAKAY CRAFT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 DOGPATCH TRADING CTR STE 1
LONDON KY
40741-8292
US

IV. Provider business mailing address

797 CORNETT CHAPEL RD
ANNVILLE KY
40402-9712
US

V. Phone/Fax

Practice location:
  • Phone: 606-260-8905
  • Fax:
Mailing address:
  • Phone: 859-408-3115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW00001790
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: