Provider Demographics
NPI:1972264760
Name:KEITEL, KELSEE (MS ED, LMHCA, NCC)
Entity Type:Individual
Prefix:
First Name:KELSEE
Middle Name:
Last Name:KEITEL
Suffix:
Gender:F
Credentials:MS ED, LMHCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-5216
Mailing Address - Country:US
Mailing Address - Phone:812-457-3308
Mailing Address - Fax:
Practice Address - Street 1:941 E 86TH ST STE 112
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1842
Practice Address - Country:US
Practice Address - Phone:812-457-3308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88000927A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health