Healthcare Provider Details

I. General information

NPI: 1558274134
Provider Name (Legal Business Name): KELLY SIMMONS MA, LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3006 S SAND DUNES DR
HILLSDALE MI
49242-9667
US

IV. Provider business mailing address

3006 S SAND DUNES DR
HILLSDALE MI
49242-9667
US

V. Phone/Fax

Practice location:
  • Phone: 615-707-3781
  • Fax:
Mailing address:
  • Phone: 615-707-3781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451025380
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: