Healthcare Provider Details

I. General information

NPI: 1982519005
Provider Name (Legal Business Name): ANDREA KELLY LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 JENNER DR
ALLEGAN MI
49010-1517
US

IV. Provider business mailing address

540 JENNER DR
ALLEGAN MI
49010-1517
US

V. Phone/Fax

Practice location:
  • Phone: 269-673-6617
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451024353
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: