Provider Demographics
NPI:1023557774
Name:DONOHO, KELSEY
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:DONOHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6277 LACENTER RD
Mailing Address - Street 2:
Mailing Address - City:LACENTER
Mailing Address - State:KY
Mailing Address - Zip Code:42056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6277 LACENTER RD
Practice Address - Street 2:
Practice Address - City:LACENTER
Practice Address - State:KY
Practice Address - Zip Code:42056
Practice Address - Country:US
Practice Address - Phone:270-908-0461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRBT-16-22193106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician