Provider Demographics
NPI:1245391010
Name:KESSELMAN, IDELL NANCY (LPC)
Entity Type:Individual
Prefix:
First Name:IDELL
Middle Name:NANCY
Last Name:KESSELMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:IDELL
Other - Middle Name:NANCY
Other - Last Name:JACOBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4201 N 16TH ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5347
Mailing Address - Country:US
Mailing Address - Phone:602-248-9247
Mailing Address - Fax:602-248-8936
Practice Address - Street 1:4201 N 16TH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5347
Practice Address - Country:US
Practice Address - Phone:602-248-9247
Practice Address - Fax:602-248-8936
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC1265101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health