Provider Demographics
NPI:1093924862
Name:KEKHOUA, JOELLE CATHERINE (MA, LLP, LLPC, NCP)
Entity Type:Individual
Prefix:
First Name:JOELLE
Middle Name:CATHERINE
Last Name:KEKHOUA
Suffix:
Gender:F
Credentials:MA, LLP, LLPC, NCP
Other - Prefix:
Other - First Name:JOELLE
Other - Middle Name:C
Other - Last Name:LUCIDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LLP, LLPC, NCP
Mailing Address - Street 1:425 S MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6729
Mailing Address - Country:US
Mailing Address - Phone:248-601-3111
Mailing Address - Fax:
Practice Address - Street 1:425 S MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-6729
Practice Address - Country:US
Practice Address - Phone:248-601-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010294101YP2500X
MI6301010407103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional