Healthcare Provider Details

I. General information

NPI: 1699585737
Provider Name (Legal Business Name): KELLY ANN MACHIORLATTI MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 OTTAWA AVE NW STE 425
GRAND RAPIDS MI
49503-2648
US

IV. Provider business mailing address

2127 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2114
US

V. Phone/Fax

Practice location:
  • Phone: 616-920-0022
  • Fax: 616-616-5680
Mailing address:
  • Phone: 616-617-7378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451024729
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: