Provider Demographics
NPI:1659706760
Name:SHANHOLTZ, KELSEY (BA)
Entity Type:Individual
Prefix:MISS
First Name:KELSEY
Middle Name:
Last Name:SHANHOLTZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 TENNYSON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-2942
Mailing Address - Country:US
Mailing Address - Phone:540-233-1503
Mailing Address - Fax:
Practice Address - Street 1:799 TENNYSON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-2942
Practice Address - Country:US
Practice Address - Phone:540-233-1503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-08
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist