Provider Demographics
NPI:1538668355
Name:HOMAN, KELSI (LPCC)
Entity Type:Individual
Prefix:
First Name:KELSI
Middle Name:
Last Name:HOMAN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:KELSI
Other - Middle Name:
Other - Last Name:MCCLAFLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 9859
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58106-9859
Mailing Address - Country:US
Mailing Address - Phone:701-451-4900
Mailing Address - Fax:651-925-0057
Practice Address - Street 1:815 37TH AVE S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5524
Practice Address - Country:US
Practice Address - Phone:701-451-4811
Practice Address - Fax:651-925-0057
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MN2422101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician