Provider Demographics
NPI:1669950820
Name:STAUB, KELSEY (LPC-A)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:STAUB
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 FOREST HILL DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2417
Mailing Address - Country:US
Mailing Address - Phone:515-326-1216
Mailing Address - Fax:
Practice Address - Street 1:1316 PATTON AVE STE D
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2652
Practice Address - Country:US
Practice Address - Phone:828-225-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14188101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP586677Medicaid