Healthcare Provider Details

I. General information

NPI: 1831975044
Provider Name (Legal Business Name): KELSEY CREELMAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 09/04/2023
Certification Date: 09/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 GRANDE BLVD SE STE D
RIO RANCHO NM
87124-0300
US

IV. Provider business mailing address

3612 MARY ELLEN ST NE
ALBUQUERQUE NM
87111-4804
US

V. Phone/Fax

Practice location:
  • Phone: 906-369-3197
  • Fax:
Mailing address:
  • Phone: 906-369-3197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2023-0128
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: