Provider Demographics
NPI:1619583366
Name:ULLRICH, KELSEY (MA, LPCC)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:ULLRICH
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 GONZALES RD LOT 9
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-6151
Mailing Address - Country:US
Mailing Address - Phone:901-230-0241
Mailing Address - Fax:
Practice Address - Street 1:690 GONZALES RD LOT 9
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-6151
Practice Address - Country:US
Practice Address - Phone:901-230-0241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2024-0109101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health