Provider Demographics
NPI:1952113714
Name:KINTZ, KELSEY E (LSW)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:E
Last Name:KINTZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11756 BOARDWALK LN
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-8790
Mailing Address - Country:US
Mailing Address - Phone:260-760-5687
Mailing Address - Fax:
Practice Address - Street 1:9780 LANTERN RD STE 350
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-4093
Practice Address - Country:US
Practice Address - Phone:317-520-1114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33012062A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical