| Doctor Name: | DR. THERESA K KELSO |
| NPI Number: | 1083797682 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D |
| License Number: | 35S1002377 |
| Business Practice Address: | 420 Boulevard Suite 208 Mountain Lakes, NJ - 070461742 |
| Business Phone Number: | 9732992888 |
| Business Fax Number: | 9732992876 |
| Mailing Address: | 420 Boulevard, Suite 208 MOUNTAIN LAKES |
| State: | NJ |
| Postal Code: | 070461742 |
| Phone Number: | 9732992888 |
| Fax Number: | 9732992876 |
| NPI Enumeration Date: | 10/24/2006 |
| NPI Last Update Date: | 07/08/2007 |
| 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: | |