Provider Demographics
NPI:1013027820
Name:KELZER, TERESA JUNE (LSCSW)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:JUNE
Last Name:KELZER
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 S CUSTER ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-2521
Mailing Address - Country:US
Mailing Address - Phone:316-737-0544
Mailing Address - Fax:316-943-1773
Practice Address - Street 1:10209 W CENTRAL AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4684
Practice Address - Country:US
Practice Address - Phone:316-737-0544
Practice Address - Fax:316-943-1773
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS25201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical