Provider Demographics
NPI:1952828014
Name:TIERNON, KELSEY E (MA)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:E
Last Name:TIERNON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 BEINEKE RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46808-1627
Mailing Address - Country:US
Mailing Address - Phone:260-310-3266
Mailing Address - Fax:
Practice Address - Street 1:3478 STELLHORN RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-4630
Practice Address - Country:US
Practice Address - Phone:260-452-5336
Practice Address - Fax:260-387-5075
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health