Provider Demographics
NPI:1821581406
Name:CHURCHILL, KELSIE LYNN (BS,QMHS)
Entity Type:Individual
Prefix:
First Name:KELSIE
Middle Name:LYNN
Last Name:CHURCHILL
Suffix:
Gender:F
Credentials:BS,QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 BELL ST
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1720
Mailing Address - Country:US
Mailing Address - Phone:740-454-9766
Mailing Address - Fax:740-588-6452
Practice Address - Street 1:44020 MARIETTA RD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:OH
Practice Address - Zip Code:43724-9124
Practice Address - Country:US
Practice Address - Phone:740-732-5233
Practice Address - Fax:740-732-4777
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0291728Medicaid