Provider Demographics
NPI:1356119010
Name:POOLE, KELSEY RYAN (MS, LPC)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:RYAN
Last Name:POOLE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 HUDSON BLVD
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-4790
Mailing Address - Country:US
Mailing Address - Phone:214-686-5242
Mailing Address - Fax:
Practice Address - Street 1:5445 LEGACY DR STE 270
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3363
Practice Address - Country:US
Practice Address - Phone:972-865-8782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88165101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional