Healthcare Provider Details

I. General information

NPI: 1154763480
Provider Name (Legal Business Name): ROZANA JEAN KELLY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 GREEN RD
ANN ARBOR MI
48105-1599
US

IV. Provider business mailing address

PO BOX 980362
YPSILANTI MI
48198-0362
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-3732
  • Fax:
Mailing address:
  • Phone: 313-870-8512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401013788
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401013788
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: