Provider Demographics
NPI:1740680156
Name:KLEIN, KELSEY MARIE
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:MARIE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 COURT ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89501-1708
Mailing Address - Country:US
Mailing Address - Phone:775-302-9973
Mailing Address - Fax:775-302-9931
Practice Address - Street 1:435 COURT ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-1708
Practice Address - Country:US
Practice Address - Phone:775-302-9973
Practice Address - Fax:775-302-9931
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
NVCP5086101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist