Healthcare Provider Details

I. General information

NPI: 1053795062
Provider Name (Legal Business Name): CELIA PARTIDA KELLY MA,LPC,CAADC,CTP,EMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 M 66 N
CHARLEVOIX MI
49720-9338
US

IV. Provider business mailing address

101 M 66 N
CHARLEVOIX MI
49720-9338
US

V. Phone/Fax

Practice location:
  • Phone: 231-547-1144
  • Fax: 231-547-4970
Mailing address:
  • Phone: 231-547-1144
  • Fax: 231-547-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401014750
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6803063798
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401014750
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: