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NPI Code Detail

MEDICARE: MRS. JEANNIE N KELSO LCSW

MEDICARE: MRS. JEANNIE N KELSO LCSW
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
1101YM0800XMental Health CounselorC7281MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225183056
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JEANNIE N KELSO LCSW
Provider Business Mailing Address
First Line : 1514 SHERMAN AVE
Second Line :
City : JACKSON
State : MS
Zip : 39211-2129
Country : US
Telephone Number : 601-398-0989
Fax Number :
Provider Business Practice Location Address
First Line : 1059 RIDGEWOOD PL
Second Line :
City : JACKSON
State : MS
Zip : 39211-2018
Country : US
Telephone Number : 601-957-3211
Fax Number : 601-957-9753
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2007
Last Update Date : 07/09/2007

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