MEDICARE: KELLY M MICHAUD LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12610067	OTHER	GA	CAQH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447588363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY M MICHAUD LPC

Provider Business Mailing Address
First Line	:	345 W MEMORIAL DR
Second Line	:
City	:	HINESVILLE
State	:	GA
Zip	:	31313-2413
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	345 W MEMORIAL DR
Second Line	:
City	:	HINESVILLE
State	:	GA
Zip	:	31313-2413
Country	:	US
Telephone Number	:	912-456-2010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2009
Last Update Date	:	05/01/2025

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