Provider Demographics
NPI:1134986425
Name:KELLY COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:KELLY COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:DOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LMFT
Authorized Official - Phone:970-576-1717
Mailing Address - Street 1:1681 CLARENDON DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-2887
Mailing Address - Country:US
Mailing Address - Phone:970-430-6127
Mailing Address - Fax:
Practice Address - Street 1:760 WHALERS WAY UNIT 10
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3370
Practice Address - Country:US
Practice Address - Phone:970-430-6127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty