Provider Demographics
NPI:1619903374
Name:KELSO, HAROLD G (PHD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:G
Last Name:KELSO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 STETSON STREET
Mailing Address - Street 2:ML 0530 SUITE 5200
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45267-0530
Mailing Address - Country:US
Mailing Address - Phone:513-558-2919
Mailing Address - Fax:513-558-4458
Practice Address - Street 1:222 PIEDMONT AVE
Practice Address - Street 2:SUITE 3400
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-4231
Practice Address - Country:US
Practice Address - Phone:513-475-7718
Practice Address - Fax:513-475-7711
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3910103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000012171OtherANTHEM
KY89540157Medicaid
OH0168107Medicaid
IN200510310Medicaid
IN200510310Medicaid