Doctor Name: | MRS. K. MICHELLE KELLY |
NPI Number: | 1073934105 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LSW, LPCC |
License Number: | C.1300607 |
Business Practice Address: | 2587 Back Orrville Rd Wooster, OH - 446919523 |
Business Phone Number: | 3302649579 |
Business Fax Number: | 3302640946 |
Mailing Address: | 2587 Back Orrville Rd, WOOSTER |
State: | OH |
Postal Code: | 446919523 |
Phone Number: | 3302649579 |
Fax Number: | 3302640946 |
NPI Enumeration Date: | 12/16/2013 |
NPI Last Update Date: | 04/05/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP1600X |
License Number: | C.1300607 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Pastoral |
Taxonomy Definition: |