Provider Demographics
NPI:1376061093
Name:FOX, KELSEY (LISW)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9905 MAD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NEW VIENNA
Mailing Address - State:OH
Mailing Address - Zip Code:45159-9403
Mailing Address - Country:US
Mailing Address - Phone:937-763-9801
Mailing Address - Fax:
Practice Address - Street 1:2556 LEBANON RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:45113-8201
Practice Address - Country:US
Practice Address - Phone:937-763-9801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.2405345104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker