Provider Demographics
NPI:1619410149
Name:FLEET, KELSEY
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:FLEET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E WILLIAM ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-4017
Mailing Address - Country:US
Mailing Address - Phone:316-201-3125
Mailing Address - Fax:
Practice Address - Street 1:209 E WILLIAM ST
Practice Address - Street 2:SUITE 501
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-4017
Practice Address - Country:US
Practice Address - Phone:316-201-3125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2609103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist