Basic Information
| Provider Information | |||||||||
| NPI: | 1073964672 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SALAZAR | ||||||||
| FirstName: | KELSEY | ||||||||
| MiddleName: | JOY | ||||||||
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| Credential: | MS, LCPC, CSOTP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1576 S GOEBEL CIR | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672074008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7797773976 | ||||||||
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| Practice Location | |||||||||
| Address1: | 24401 W MACARTHUR RD | ||||||||
| Address2: | |||||||||
| City: | GODDARD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670528713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3167942760 | ||||||||
| FaxNumber: | 3167942773 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2016 | ||||||||
| LastUpdateDate: | 01/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 180011268 | IL | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 2655 | KS | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 1811327950 | 05 | KS | MEDICAID |