Healthcare Provider Details

I. General information

NPI: 1194696708
Provider Name (Legal Business Name): KELSEY TRENAE ONEAL M.ED, LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4126 RIVER PARK DR
LOUISVILLE KY
40211-3169
US

IV. Provider business mailing address

4126 RIVER PARK DR
LOUISVILLE KY
40211-3169
US

V. Phone/Fax

Practice location:
  • Phone: 855-591-0092
  • Fax: 502-631-9660
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number300234
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: