Provider Demographics
NPI:1508427923
Name:GROVE, KELSI R (LPC)
Entity Type:Individual
Prefix:
First Name:KELSI
Middle Name:R
Last Name:GROVE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8116 ANTIOCH RD
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-3533
Mailing Address - Country:US
Mailing Address - Phone:402-304-5597
Mailing Address - Fax:
Practice Address - Street 1:11695 S BLACKBOB RD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1058
Practice Address - Country:US
Practice Address - Phone:913-768-6606
Practice Address - Fax:913-768-6609
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3430101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor