Provider Demographics
NPI:1174954911
Name:KELSAY, SUSAN LOUISE (LMFTA)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LOUISE
Last Name:KELSAY
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SE 124TH AVE.
Mailing Address - Street 2:#203
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684
Mailing Address - Country:US
Mailing Address - Phone:360-524-4828
Mailing Address - Fax:866-712-6982
Practice Address - Street 1:201 SE 124TH AVE.
Practice Address - Street 2:#203
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684
Practice Address - Country:US
Practice Address - Phone:360-524-4828
Practice Address - Fax:866-712-6982
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60416613106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist