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General NPI Number Information
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NPI Number | 1780382804
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Entity Type | Organization
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Legal Business Name | KOSELIG HEALTH SERVICES PLLC
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Dates
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Enumeration Date | 02/17/2023
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 103 SUBURBAN RD STE D102
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City | KNOXVILLE
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State | TN
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Zip | 37923-5581
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Country | US
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Telephone | 865-424-7334
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10963
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City | KNOXVILLE
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State | TN
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Zip | 37939-0963
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | MS. KELSEY WALLACE
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Credential | APRN
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Telephone | 813-629-0250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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