Provider Demographics
NPI:1740321587
Name:VAN DUSEN, KELSEY LEIGH (LMHP)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:LEIGH
Last Name:VAN DUSEN
Suffix:
Gender:F
Credentials:LMHP
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 22
Mailing Address - Street 2:1303 GRANT
Mailing Address - City:SAINT PAUL
Mailing Address - State:NE
Mailing Address - Zip Code:68873-0022
Mailing Address - Country:US
Mailing Address - Phone:308-750-3578
Mailing Address - Fax:
Practice Address - Street 1:615 N ELM ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-4254
Practice Address - Country:US
Practice Address - Phone:308-379-2242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2754101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health