MEDICARE: GAY S KELSO, DBA SOLUTION FOCUSED COUNSELING

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	1041C0700X	Clinical Social Worker	37181	TX

General Provider Information

NPI Number	:	1205116407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GAY S KELSO, DBA SOLUTION FOCUSED COUNSELING

Provider Business Mailing Address
First Line	:	7833 OAKMONT BLVD
Second Line	:	SUITE 110
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4231
Country	:	US
Telephone Number	:	817-665-0583
Fax Number	:	817-370-8977

Provider Business Practice Location Address
First Line	:	7833 OAKMONT BLVD
Second Line	:	SUITE 110
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4231
Country	:	US
Telephone Number	:	817-665-0583
Fax Number	:	817-370-8977

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. GAY S KELSO
Credential	:	LCSW
Telephone Number	:	817-846-8380

Provider Enumeration Date	:	08/19/2011
Last Update Date	:	08/19/2011

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