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General NPI Number Information
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NPI Number | 1699585737
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Entity Type | Individual
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Provider Name | KELLY ANN MACHIORLATTI MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 01/10/2025
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 80 OTTAWA AVE NW STE 425
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2648
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Country | US
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Telephone | 616-920-0022
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Fax | 616-616-5680
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Provider Business Mailing Address
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Address Line | 2127 MICHIGAN ST NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2114
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Country | US
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Telephone | 616-617-7378
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6451024729
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License Number State | MI
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