Provider Demographics
NPI:1174109722
Name:THAMES, KELSA (LMSW)
Entity type:Individual
Prefix:
First Name:KELSA
Middle Name:
Last Name:THAMES
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 1:412 ANNABROOK ST
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-3754
Mailing Address - Country:US
Mailing Address - Phone:601-532-0564
Mailing Address - Fax:
Practice Address - Street 1:300 RAWLS DR
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2877
Practice Address - Country:US
Practice Address - Phone:601-684-8284
Practice Address - Fax:601-684-8199
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM92851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical