Individual
KELSEY MCNICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHP
Contact information
Practice address
206 W 5TH ST, METROPOLIS, IL 62960-1810
(618) 524-9368
Mailing address
6667 POWERS CHURCH RD, METROPOLIS, IL 62960-6029
(618) 645-2028
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101Y00000X
ANY OTHER
IL
05
—
101Y00000X
—
IL
Enumeration date
01/31/2020
Last updated
02/05/2020
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