Provider Demographics
NPI:1740775956
Name:PRITCHARD, KELSEY (PHD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:PRITCHARD
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 1:1200 S. DETROIT AVE
Mailing Address - Street 2:TOLEDO COMMUNITY-BASED OUTPATIENT CLINIC
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614
Mailing Address - Country:US
Mailing Address - Phone:419-213-7629
Mailing Address - Fax:419-213-7631
Practice Address - Street 1:1200 S. DETROIT AVE
Practice Address - Street 2:TOLEDO COMMUNITY-BASED OUTPATIENT CLINIC
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614
Practice Address - Country:US
Practice Address - Phone:419-213-7629
Practice Address - Fax:419-213-7631
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.08384103T00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program