MEDICARE: KELSEY DOMANN-SCHOLZ LPCA, NCC, MA

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	A12273	NC

General Provider Information

NPI Number	:	1447604822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY DOMANN-SCHOLZ LPCA, NCC, MA

Provider Business Mailing Address
First Line	:	1426 IDA ST APT A
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-3330
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1426 IDA ST APT A
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-3330
Country	:	US
Telephone Number	:	503-407-1740
Fax Number	:

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

Provider Enumeration Date	:	04/21/2016
Last Update Date	:	04/21/2016

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