Provider Demographics
NPI:1790454890
Name:EWER, KELSEY LEE (PCLC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:LEE
Last Name:EWER
Suffix:
Gender:F
Credentials:PCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2480
Mailing Address - Country:US
Mailing Address - Phone:406-541-0032
Mailing Address - Fax:406-541-0036
Practice Address - Street 1:316 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2480
Practice Address - Country:US
Practice Address - Phone:406-541-0032
Practice Address - Fax:406-541-0036
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-50312101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health