Provider Demographics
NPI:1235430802
Name:HOERAUF, KELSY D (LMFT)
Entity Type:Individual
Prefix:
First Name:KELSY
Middle Name:D
Last Name:HOERAUF
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KELSY
Other - Middle Name:D
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:515 RIDGEWOOD
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-9164
Mailing Address - Country:US
Mailing Address - Phone:810-730-5444
Mailing Address - Fax:
Practice Address - Street 1:4031 OWEN RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-9100
Practice Address - Country:US
Practice Address - Phone:810-730-5444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MIL2136200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)