Provider Demographics
NPI:1164171401
Name:RENZELLA, KELSEY (LGSW)
Entity Type:Individual
Prefix:MS
First Name:KELSEY
Middle Name:
Last Name:RENZELLA
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 MAIN ST STE 502
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-2726
Mailing Address - Country:US
Mailing Address - Phone:304-233-2020
Mailing Address - Fax:304-233-0858
Practice Address - Street 1:1025 MAIN ST STE 502
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-2726
Practice Address - Country:US
Practice Address - Phone:304-233-2020
Practice Address - Fax:304-233-8058
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool