Provider Demographics
NPI:1780118851
Name:PERKINS, KELCEY ELAINE (PSYD)
Entity type:Individual
Prefix:
First Name:KELCEY
Middle Name:ELAINE
Last Name:PERKINS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703-1642
Mailing Address - Country:US
Mailing Address - Phone:304-697-1396
Mailing Address - Fax:304-697-2086
Practice Address - Street 1:1 HARBOUR WAY
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WV
Practice Address - Zip Code:25541-1545
Practice Address - Country:US
Practice Address - Phone:304-781-5050
Practice Address - Fax:304-781-5051
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100458750Medicaid
OH0222658Medicaid
WV1780118851Medicaid
Q56841OtherMEDICARE FFS