Healthcare Provider Details

I. General information

NPI: 1023928116
Provider Name (Legal Business Name): KARLI MALLETTE MA, LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1861 RW BERENDS DR SW
WYOMING MI
49519-4955
US

IV. Provider business mailing address

1861 RW BERENDS DR SW
WYOMING MI
49519-4955
US

V. Phone/Fax

Practice location:
  • Phone: 616-320-5111
  • Fax: 877-537-6994
Mailing address:
  • Phone: 616-320-5111
  • Fax: 877-537-6994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451025339
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: