Provider Demographics
NPI:1013635648
Name:THOMAS, KELSIE LYNNE (LMSW)
Entity Type:Individual
Prefix:
First Name:KELSIE
Middle Name:LYNNE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 CHARLEVOIX DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-2223
Mailing Address - Country:US
Mailing Address - Phone:517-627-2181
Mailing Address - Fax:517-622-1242
Practice Address - Street 1:1035 CHARLEVOIX DR STE 100
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-2223
Practice Address - Country:US
Practice Address - Phone:517-622-6475
Practice Address - Fax:517-622-1242
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801114644101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801114644OtherSTATE LICENSE NUMBER