Provider Demographics
NPI:1134019532
Name:WHITE, KELSEY MICHELLE
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:MICHELLE
Last Name:WHITE
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 1:2015 N WEST BAY DR APT G
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-7669
Mailing Address - Country:US
Mailing Address - Phone:765-524-6210
Mailing Address - Fax:
Practice Address - Street 1:2015 N WEST BAY DR
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-7667
Practice Address - Country:US
Practice Address - Phone:765-524-6210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker