Provider Demographics
NPI:1053821009
Name:KELSEY, RYAN NICOLE (LPC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:NICOLE
Last Name:KELSEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 GRAND CANYON PKWY APT 203
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1707
Mailing Address - Country:US
Mailing Address - Phone:815-685-0345
Mailing Address - Fax:
Practice Address - Street 1:959 GRAND CANYON PKWY APT 203
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1707
Practice Address - Country:US
Practice Address - Phone:815-685-0345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-04
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178011439101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional