Provider Demographics
NPI:1619520020
Name:SOLES, KELSEY SHANNON
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:SHANNON
Last Name:SOLES
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 1:30863 301ST ST
Mailing Address - Street 2:
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580-6216
Mailing Address - Country:US
Mailing Address - Phone:605-208-4047
Mailing Address - Fax:
Practice Address - Street 1:841 JACKSON ST STE C
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:SD
Practice Address - Zip Code:57523-2065
Practice Address - Country:US
Practice Address - Phone:605-494-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC20398101YM0800X
SDLPC-MH30578101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health