Provider Demographics
NPI:1841812641
Name:RICHMOND, KELSEY (PSYD, LP)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD, LP
Mailing Address - Street 1:1547 STRONGS AVE STE D
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-3566
Mailing Address - Country:US
Mailing Address - Phone:715-303-2900
Mailing Address - Fax:715-303-2928
Practice Address - Street 1:1547 STRONGS AVE STE D
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-3566
Practice Address - Country:US
Practice Address - Phone:715-303-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2856-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical