Provider Demographics
NPI:1235510397
Name:MEREDITH, KELSI (LCSW)
Entity Type:Individual
Prefix:
First Name:KELSI
Middle Name:
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1553 AVENIDA DE QUINTAS
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3506
Mailing Address - Country:US
Mailing Address - Phone:480-209-9698
Mailing Address - Fax:
Practice Address - Street 1:1553 AVENIDA DE QUINTAS
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3506
Practice Address - Country:US
Practice Address - Phone:480-209-9698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-09128104100000X
NMC-116111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker