Healthcare Provider Details

I. General information

NPI: 1619903374
Provider Name (Legal Business Name): HAROLD G. KELSO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 PIEDMONT AVE SUITE 3400
CINCINNATI OH
45219-4231
US

IV. Provider business mailing address

260 STETSON STREET ML 0530 SUITE 5200
CINCINNATI OH
45267-0530
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-7718
  • Fax: 513-475-7711
Mailing address:
  • Phone: 513-558-2919
  • Fax: 513-558-4458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3910
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: