Provider Demographics
NPI:1942657275
Name:SCANLAN, KELSEY L (LPCC-S)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:L
Last Name:SCANLAN
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:L
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 KOONS DR
Mailing Address - Street 2:
Mailing Address - City:ENON
Mailing Address - State:OH
Mailing Address - Zip Code:45323-1030
Mailing Address - Country:US
Mailing Address - Phone:937-901-8426
Mailing Address - Fax:
Practice Address - Street 1:30 KOONS DR
Practice Address - Street 2:
Practice Address - City:ENON
Practice Address - State:OH
Practice Address - Zip Code:45323-1030
Practice Address - Country:US
Practice Address - Phone:937-901-8426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE1800869-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional