Provider Demographics
NPI:1235431446
Name:KELLAR, MICHELLE (LMHC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:KELLAR
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1059
Mailing Address - Country:US
Mailing Address - Phone:641-620-9094
Mailing Address - Fax:
Practice Address - Street 1:1121 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1229
Practice Address - Country:US
Practice Address - Phone:641-628-1623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00889101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health