MEDICARE: STEPHANIE KELSEY MA, LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPCC.0023981	CO

General Provider Information

NPI Number	:	1144192485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE KELSEY MA, LPCC

Provider Business Mailing Address
First Line	:	715 PEARL ST
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80302-5005
Country	:	US
Telephone Number	:	303-731-6142
Fax Number	:

Provider Business Practice Location Address
First Line	:	5353 W DARTMOUTH AVE STE 305
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-5517
Country	:	US
Telephone Number	:	720-943-7080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2025
Last Update Date	:	09/18/2025

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