Provider Demographics
NPI:1174093801
Name:FROMAL, KELSEY JANSER (MED, CCLS)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:JANSER
Last Name:FROMAL
Suffix:
Gender:F
Credentials:MED, CCLS
Other - Prefix:MISS
Other - First Name:KELSEY
Other - Middle Name:ELIZABETH
Other - Last Name:JANSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, CCLS
Mailing Address - Street 1:44 VANTAGE WAY
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44 VANTAGE WAY
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1513
Practice Address - Country:US
Practice Address - Phone:888-291-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health