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General NPI Number Information
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NPI Number | 1760299747
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Entity Type | Individual
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Provider Name | KELLY REAN KOERNER
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Gender | Female
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 3003 E MICHIGAN AVE STE 1139
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City | LANSING
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State | MI
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Zip | 48912-4616
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Country | US
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Telephone | 517-816-9018
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Fax |
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Provider Business Mailing Address
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Address Line | 601 CAMROSE CT
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City | LAINGSBURG
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State | MI
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Zip | 48848-9809
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Country | US
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Telephone |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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