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General NPI Number Information
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NPI Number | 1871920546
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Entity Type | Individual
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Provider Name | BOBBI JAE KELSEY LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/26/2013
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Last Update Date | 09/19/2018
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Provider Practice Location Address
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Address Line | 822 WASHINGTON ST
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City | MONTPELIER
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State | ID
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Zip | 83254-1423
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Country | US
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Telephone | 208-847-4464
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Fax | 208-847-4251
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Provider Business Mailing Address
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Address Line | 1100 TORREY RD STE 100
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City | FENTON
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State | MI
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Zip | 48430-3327
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Country | US
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Telephone | 208-847-4464
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Fax | 208-847-4251
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 17440
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCSW-35444
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License Number State | ID
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