Provider Demographics
NPI:1013788272
Name:DAHLIN, KELSEY RAE (MA)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:RAE
Last Name:DAHLIN
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: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 1:59 MESA RD
Practice Address - Street 2:
Practice Address - City:CLIFF
Practice Address - State:NM
Practice Address - Zip Code:88028-1229
Practice Address - Country:US
Practice Address - Phone:575-956-3313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No347B00000XTransportation ServicesBus