Provider Demographics
NPI:1548155930
Name:SCOTT, KELLSEY IMANI
Entity type:Individual
Prefix:
First Name:KELLSEY
Middle Name:IMANI
Last Name:SCOTT
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 1:7467 E FURNACE BRANCH RD APT E
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-7259
Mailing Address - Country:US
Mailing Address - Phone:443-942-5700
Mailing Address - Fax:
Practice Address - Street 1:7467 E FURNACE BRANCH RD APT E
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-7259
Practice Address - Country:US
Practice Address - Phone:443-942-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician