Provider Demographics
NPI:1528565793
Name:RATHER, KELSI ANNE
Entity Type:Individual
Prefix:
First Name:KELSI
Middle Name:ANNE
Last Name:RATHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18301 N 79TH AVE STE C133
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8471
Mailing Address - Country:US
Mailing Address - Phone:623-748-3337
Mailing Address - Fax:623-234-3751
Practice Address - Street 1:18301 N 79TH AVE STE C133
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8471
Practice Address - Country:US
Practice Address - Phone:623-748-3337
Practice Address - Fax:623-234-3751
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-17140101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty