Provider Demographics
NPI:1467828194
Name:PAVLIDIS, KELSEY L (LCSW, MSW)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:L
Last Name:PAVLIDIS
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:L
Other - Last Name:MOLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, MSW
Mailing Address - Street 1:4856 INNOVATION DR STE B
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5540
Mailing Address - Country:US
Mailing Address - Phone:970-494-4200
Mailing Address - Fax:
Practice Address - Street 1:221 E 29TH ST STE 101
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538
Practice Address - Country:US
Practice Address - Phone:970-494-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099254591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical