| Organization Name: | T. K. KELSO, PSY.D, LLC |
| NPI Number: | 1033369699 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | THERESA K KELSO (OWNER) |
| Mailing Address: | 420 Boulevard, Suite 208 Mountain Lakes |
| State: | NJ US |
| Postal Code: | 070461742 |
| Phone Number: | 9732992888 |
| Fax Number: | 9732992876 |
| NPI Enumeration Date: | 09/19/2008 |
| NPI Last Update Date: | 12/29/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 35S1002377 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |