Provider Demographics
NPI:1043756992
Name:CLUTE, KELLY M
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:M
Last Name:CLUTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12249 US HIGHWAY 223
Mailing Address - Street 2:
Mailing Address - City:RIGA
Mailing Address - State:MI
Mailing Address - Zip Code:49276-9784
Mailing Address - Country:US
Mailing Address - Phone:248-240-4323
Mailing Address - Fax:
Practice Address - Street 1:805 W MAUMEE ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1901
Practice Address - Country:US
Practice Address - Phone:517-266-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)