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General NPI Number Information
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NPI Number | 1134986425
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Entity Type | Organization
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Legal Business Name | KELLY COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 03/04/2024
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 760 WHALERS WAY UNIT 10
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City | FORT COLLINS
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State | CO
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Zip | 80525-3370
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Country | US
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Telephone | 970-430-6127
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Fax |
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Provider Business Mailing Address
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Address Line | 1681 CLARENDON DR
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City | WINDSOR
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State | CO
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Zip | 80550-2887
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Country | US
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Telephone | 970-430-6127
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | DAMOND DOTSON
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Credential | PHD LMFT
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Telephone | 970-576-1717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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