Provider Demographics
NPI:1437449006
Name:THOMPSON, KELSEY LEIGH (MS, CRC, CCM, LCPC)
Entity Type:Individual
Prefix:MS
First Name:KELSEY
Middle Name:LEIGH
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MS, CRC, CCM, LCPC
Other - Prefix:MS
Other - First Name:KELSEY
Other - Middle Name:LEIGH
Other - Last Name:DALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1822 W CHASE AVE
Mailing Address - Street 2:UNIT G
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-2369
Mailing Address - Country:US
Mailing Address - Phone:773-550-5456
Mailing Address - Fax:312-243-8539
Practice Address - Street 1:1822 W CHASE AVE
Practice Address - Street 2:UNIT G
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-2369
Practice Address - Country:US
Practice Address - Phone:773-550-5456
Practice Address - Fax:312-243-8539
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007486101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor