Healthcare Provider Details

I. General information

NPI: 1043925829
Provider Name (Legal Business Name): DANIELLE N KELSEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANIELLE N MUHLENA

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 LUSK DR STE 112
NEOSHO MO
64850-2010
US

IV. Provider business mailing address

3101 LUSK DR STE 112
NEOSHO MO
64850-2010
US

V. Phone/Fax

Practice location:
  • Phone: 417-596-2415
  • Fax:
Mailing address:
  • Phone: 417-596-2415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2023000905
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: