Provider Demographics
NPI:1497848782
Name:MELANIE KELSEY LCSW PC
Entity Type:Organization
Organization Name:MELANIE KELSEY LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELSEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-608-6850
Mailing Address - Street 1:PO BOX 1632
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-0125
Mailing Address - Country:US
Mailing Address - Phone:541-608-6850
Mailing Address - Fax:541-608-3880
Practice Address - Street 1:955 TOWN CENTRE DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-608-6850
Practice Address - Fax:541-608-3880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-01
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL19851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR115482Medicare PIN
OR115482Medicare ID - Type Unspecified