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General NPI Number Information
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NPI Number | 1205303369
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Entity Type | Organization
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Legal Business Name | KELSY HOERAUF PC
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Dates
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Enumeration Date | 10/26/2018
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Last Update Date | 10/26/2018
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Provider Practice Location Address
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Address Line | 4031 OWEN RD
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City | FENTON
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State | MI
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Zip | 48430-9100
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Country | US
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Telephone | 810-730-5444
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Fax |
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Provider Business Mailing Address
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Address Line | 515 RIDGEWOOD
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City | LINDEN
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State | MI
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Zip | 48451-9164
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Country | US
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Telephone | 810-730-5444
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KELSY D HOERAUF
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Credential | LMFT
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Telephone | 810-730-5444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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