Provider Demographics
NPI:1407376536
Name:PENIX, KELSEY JO (LPC - MI, LMHC - NM)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:JO
Last Name:PENIX
Suffix:
Gender:F
Credentials:LPC - MI, LMHC - NM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9445 PATRICIA DR
Mailing Address - Street 2:
Mailing Address - City:OTISVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48463-9406
Mailing Address - Country:US
Mailing Address - Phone:810-210-8857
Mailing Address - Fax:
Practice Address - Street 1:9445 PATRICIA DR
Practice Address - Street 2:
Practice Address - City:OTISVILLE
Practice Address - State:MI
Practice Address - Zip Code:48463-9406
Practice Address - Country:US
Practice Address - Phone:810-210-8857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPV0000000820594101YS0200X
NMCMH0198831101YM0800X
MI6401017288101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool