Healthcare Provider Details

I. General information

NPI: 1366230823
Provider Name (Legal Business Name): DANIELLE KELSEY THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
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 Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DANIELLE KELSEY
Title or Position: OWNER
Credential:
Phone: 417-596-2415