MEDICARE: KELSEY PASSOV

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	101YP2500X	Professional Counselor	E.2505873	OH

General Provider Information

NPI Number	:	1477338333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY PASSOV

Provider Business Mailing Address
First Line	:	3681 GREEN RD STE 404
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5716
Country	:	US
Telephone Number	:	216-342-5484
Fax Number	:

Provider Business Practice Location Address
First Line	:	35010 CHARDON RD STE 200
Second Line	:
City	:	WILLOUGHBY HILLS
State	:	OH
Zip	:	44094-9011
Country	:	US
Telephone Number	:	216-342-5484
Fax Number	:

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

Provider Enumeration Date	:	08/29/2023
Last Update Date	:	10/31/2025

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Directions to “ KELSEY PASSOV ” Practice Location

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