Provider Demographics
NPI:1407490832
Name:GARCIA, KELSEY KRISTEN (LPC-IT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:KRISTEN
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2956 W STATESMAN WAY APT 101
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-4810
Mailing Address - Country:US
Mailing Address - Phone:806-787-0879
Mailing Address - Fax:
Practice Address - Street 1:6321 23RD AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-4805
Practice Address - Country:US
Practice Address - Phone:414-455-3879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4498-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional