Provider Demographics
NPI:1316391600
Name:KELLEY, MARGARET (LPC)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:PEG
Other - Middle Name:
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:6360 JACKSON RD STE A
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-7801
Mailing Address - Country:US
Mailing Address - Phone:734-277-0580
Mailing Address - Fax:734-926-9932
Practice Address - Street 1:6360 JACKSON RD STE A
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-7801
Practice Address - Country:US
Practice Address - Phone:734-277-0580
Practice Address - Fax:734-926-9932
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015337101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health