Provider Demographics
NPI:1073964672
Name:SALAZAR, KELSEY JOY (MS, LCPC, CSOTP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:JOY
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:MS, LCPC, CSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1576 S GOEBEL CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-4008
Mailing Address - Country:US
Mailing Address - Phone:779-777-3976
Mailing Address - Fax:
Practice Address - Street 1:24401 W MACARTHUR RD
Practice Address - Street 2:
Practice Address - City:GODDARD
Practice Address - State:KS
Practice Address - Zip Code:67052-8713
Practice Address - Country:US
Practice Address - Phone:316-794-2760
Practice Address - Fax:316-794-2773
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180011268101YP2500X
KS2655101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1811327950Medicaid