Provider Demographics
NPI:1174266308
Name:KELSLAN SCARBROUGH PLLC
Entity Type:Organization
Organization Name:KELSLAN SCARBROUGH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELSLAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SCARBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:206-455-0622
Mailing Address - Street 1:285 REINHARD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-2773
Mailing Address - Country:US
Mailing Address - Phone:206-455-0622
Mailing Address - Fax:
Practice Address - Street 1:385 STEWART AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-2729
Practice Address - Country:US
Practice Address - Phone:206-455-0622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-15
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0480342Medicaid