Provider Demographics
NPI:1033661301
Name:BRAND, KELSEY CABALLERO
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:CABALLERO
Last Name:BRAND
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 1:1825 BELLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-5704
Mailing Address - Country:US
Mailing Address - Phone:225-803-4467
Mailing Address - Fax:
Practice Address - Street 1:200 PARK CIRCLE DR STE 1
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-7800
Practice Address - Country:US
Practice Address - Phone:601-664-0455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-02
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health