Provider Demographics
NPI:1043734783
Name:O'BRIEN, KELLY LYNN (MSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 W HOLMES RD STE 143
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-0435
Mailing Address - Country:US
Mailing Address - Phone:231-342-2534
Mailing Address - Fax:
Practice Address - Street 1:913 W HOLMES RD STE 143
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-0435
Practice Address - Country:US
Practice Address - Phone:231-342-2534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801101597OtherSTATE OF MI LICENSE