Individual
KELSEY PHYLICIA KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
T-CADC, BA
Contact information
Practice address
623 KINGSLEY AVE, WATERLOO, IA 50701-2957
(193) 429-8989
Mailing address
1609 LILAC LN, CEDAR FALLS, IA 50613-5313
(319) 429-8989
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T17072
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
T17072
—
IA
Enumeration date
06/19/2017
Last updated
09/28/2022
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