MEDICARE: KELSEY DARMOCHWAL M.S.

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	39003938A	IN

General Provider Information

NPI Number	:	1982089371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY DARMOCHWAL M.S.

Provider Business Mailing Address
First Line	:	6435 W JEFFERSON BLVD # 220
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-6203
Country	:	US
Telephone Number	:	260-267-0234
Fax Number	:	260-264-6770

Provider Business Practice Location Address
First Line	:	2420 N COLISEUM BLVD STE 212
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-3139
Country	:	US
Telephone Number	:	260-267-0234
Fax Number	:	260-264-6770

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

Provider Enumeration Date	:	07/27/2015
Last Update Date	:	04/12/2023

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