Provider Demographics
NPI:1144493867
Name:RAMBO, KELLEY M (LSCSW, LPC, LCAC)
Entity type:Individual
Prefix:MS
First Name:KELLEY
Middle Name:M
Last Name:RAMBO
Suffix:
Gender:F
Credentials:LSCSW, LPC, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 855
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67152-0855
Mailing Address - Country:US
Mailing Address - Phone:316-500-3800
Mailing Address - Fax:316-500-3838
Practice Address - Street 1:35 NEWPORT RD
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257-5413
Practice Address - Country:US
Practice Address - Phone:603-865-1321
Practice Address - Fax:603-865-1327
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-03
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCPC-03544101Y00000X
COLPC.0018571101YM0800X
KSLCAC-00819101YA0400X
COACD.0000487101YA0400X
NH1008101YA0400X
MELC233031041C0700X
NH29251041C0700X
KS060401041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3106593Medicaid