Provider Demographics
NPI:1811569940
Name:TOBIN, KELSEY CHRISTINE
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:CHRISTINE
Last Name:TOBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 E BUCHTEL AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-2338
Mailing Address - Country:US
Mailing Address - Phone:330-535-8116
Mailing Address - Fax:
Practice Address - Street 1:3055 S STATE ROUTE 100
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-8868
Practice Address - Country:US
Practice Address - Phone:419-447-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCIII.162589101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)