Provider Demographics
NPI:1831975044
Name:CREELMAN, KELSEY (LMSW)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:CREELMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 MARY ELLEN ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-4804
Mailing Address - Country:US
Mailing Address - Phone:906-369-3197
Mailing Address - Fax:
Practice Address - Street 1:1740 GRANDE BLVD SE STE D
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-0300
Practice Address - Country:US
Practice Address - Phone:906-369-3197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2023-01281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical