Provider Demographics
NPI:1043711450
Name:COATS, KELLY (LLMSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:COATS
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 DELHI COMMERCE DR STE 4
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-2193
Mailing Address - Country:US
Mailing Address - Phone:517-480-1870
Mailing Address - Fax:517-742-7066
Practice Address - Street 1:2450 DELHI COMMERCE DR STE 4
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-2193
Practice Address - Country:US
Practice Address - Phone:517-480-1870
Practice Address - Fax:517-742-7066
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010993361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical