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Individual

KELSEY M BOLTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MA, LPC

Contact information

Practice address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4264
(417) 761-5000
(417) 761-5011
Mailing address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4264
(417) 761-5000
(417) 761-5011

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
00
MO
101YP2500X
Professional Counselor
Primary
2019044977
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0000
MO
Enumeration date
09/26/2019
Last updated
06/08/2023
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