Healthcare Provider Details

I. General information

NPI: 1720653462
Provider Name (Legal Business Name): KELSEY BRASS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 GEORGESVILLE RD
COLUMBUS OH
43228-2420
US

IV. Provider business mailing address

491 GEORGESVILLE RD
COLUMBUS OH
43228-2420
US

V. Phone/Fax

Practice location:
  • Phone: 614-618-5000
  • Fax:
Mailing address:
  • Phone: 614-618-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2305601
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: