Doctor Name: | MICHELLE KELLAR |
NPI Number: | 1235431446 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | 00889 |
Business Practice Address: | 1121 Broadway St Pella, IA - 502191229 |
Business Phone Number: | 6416281623 |
Business Fax Number: | |
Mailing Address: | 1528 Westwood Dr, PELLA |
State: | IA |
Postal Code: | 502191059 |
Phone Number: | 6416209094 |
Fax Number: | |
NPI Enumeration Date: | 11/19/2010 |
NPI Last Update Date: | 11/19/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 00889 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |