Provider Demographics
NPI:1013788272
Name:DAHLIN, KELSEY RAE (LSAA)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:RAE
Last Name:DAHLIN
Suffix:
Gender:
Credentials:LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 405
Mailing Address - Street 2:
Mailing Address - City:CLIFF
Mailing Address - State:NM
Mailing Address - Zip Code:88028-0405
Mailing Address - Country:US
Mailing Address - Phone:575-956-3313
Mailing Address - Fax:
Practice Address - Street 1:1205 N WEST ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-4635
Practice Address - Country:US
Practice Address - Phone:575-956-3313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2024-0753101YA0400X
101YM0800X, 171M00000X, 261QM0855X, 261QM2800X, 251B00000X, 261QM0801X, 347B00000X, 324500000X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No347B00000XTransportation ServicesBus
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility