Healthcare Provider Details

I. General information

NPI: 1225640360
Provider Name (Legal Business Name): KELSI BOBBITT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 BELMONT AVE
YOUNGSTOWN OH
44504
US

IV. Provider business mailing address

1815 BELMONT AVE
YOUNGSTOWN OH
44504
US

V. Phone/Fax

Practice location:
  • Phone: 330-740-9200
  • Fax:
Mailing address:
  • Phone: 330-740-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: