=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386025948
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLY ANGEL MCGHEE LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2015
-----------------------------------------------------
Last Update Date | 01/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29556 SOUTHFIELD RD STE 200
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48076-2021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 947-282-0164
-----------------------------------------------------
Fax | 888-304-7761
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11291 MCKINNEY ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48224-1114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-694-0622
-----------------------------------------------------
Fax | 888-304-7761
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 6401009379
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 6401017494
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------