Provider Demographics
NPI:1336779982
Name:MILLS, KELSEY (LCSW)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 W HEBRON PKWY STE 135
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-6345
Mailing Address - Country:US
Mailing Address - Phone:972-836-8051
Mailing Address - Fax:972-695-4005
Practice Address - Street 1:1428 W HEBRON PKWY STE 135
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6345
Practice Address - Country:US
Practice Address - Phone:972-836-8051
Practice Address - Fax:972-695-4005
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58541101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health