Provider Demographics
NPI:1740514074
Name:KELSEY, DIANA LYNN (LCPC-5415)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:KELSEY
Suffix:
Gender:F
Credentials:LCPC-5415
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 2368
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83877-2368
Mailing Address - Country:US
Mailing Address - Phone:208-661-6190
Mailing Address - Fax:888-655-0780
Practice Address - Street 1:610 W HUBBARD ST STE 128
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2286
Practice Address - Country:US
Practice Address - Phone:208-661-6190
Practice Address - Fax:888-655-0780
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4187101YM0800X
IDLCPC-5415101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health