Healthcare Provider Details

I. General information

NPI: 1083212773
Provider Name (Legal Business Name): KELSEY HUFF LCDC III
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 INDIAN WOOD CIR STE 100
MAUMEE OH
43537-4039
US

IV. Provider business mailing address

4747 MONROE ST
TOLEDO OH
43623-4307
US

V. Phone/Fax

Practice location:
  • Phone: 419-830-0078
  • Fax: 317-520-8200
Mailing address:
  • Phone:
  • Fax: 317-520-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCIII-162262
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: