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General NPI Number Information
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NPI Number | 1902947088
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Entity Type | Organization
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Legal Business Name | BAY AREA COUNSELING, LLC
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 12/18/2023
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Provider Practice Location Address
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Address Line | 3180 RACQUET CLUB DR
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-4797
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Country | US
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Telephone | 231-933-4009
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Fax | 231-933-4032
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Provider Business Mailing Address
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Address Line | PO BOX 2257
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City | CHESTERTON
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State | IN
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Zip | 46304-0357
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Country | US
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Telephone | 219-926-8320
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Fax | 219-926-3524
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Authorized Official
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Title or Position | PSYCHOLOGIST/ OWNER
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Name | KIMBERLY KELLY
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Credential | PSYD
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Telephone | 231-933-4009
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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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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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