MEDICARE: MRS. CATHLEEN M KELLY MA, LLPC

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	101Y00000X	Counselor	6401009862	MI

General Provider Information

NPI Number	:	1811159841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATHLEEN M KELLY MA, LLPC

Provider Business Mailing Address
First Line	:	1145 ARBROAK CT
Second Line	:
City	:	LAKE ORION
State	:	MI
Zip	:	48362-2580
Country	:	US
Telephone Number	:	248-892-8410
Fax Number	:

Provider Business Practice Location Address
First Line	:	1145 ARBROAK CT
Second Line	:
City	:	LAKE ORION
State	:	MI
Zip	:	48362-2580
Country	:	US
Telephone Number	:	248-892-8410
Fax Number	:

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

Provider Enumeration Date	:	07/01/2008
Last Update Date	:	07/01/2008

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