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General NPI Number Information
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NPI Number | 1124847975
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Entity Type | Organization
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Legal Business Name | KELSEY GAULT THERAPY PLLC
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 38621 DARBYSHIRE
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City | FARMINGTON HILLS
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State | MI
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Zip | 48331-2881
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Country | US
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Telephone | 248-462-6764
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Fax |
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Provider Business Mailing Address
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Address Line | 38621 DARBYSHIRE
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City | FARMINGTON HILLS
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State | MI
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Zip | 48331-2881
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Country | US
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Telephone | 248-826-4558
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER/OWNER
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Name | KELSEY GAULT
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Credential | LMSW-C, C-SSWS
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Telephone | 248-826-4558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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