Healthcare Provider Details

I. General information

NPI: 1215852108
Provider Name (Legal Business Name): KELSEY COPELAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3594 N SNYDER RD
TROTWOOD OH
45426-3835
US

IV. Provider business mailing address

12145 AMITY RD
BROOKVILLE OH
45309-9310
US

V. Phone/Fax

Practice location:
  • Phone: 937-854-3050
  • Fax:
Mailing address:
  • Phone: 937-248-4283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: