Provider Demographics
NPI:1457825531
Name:MILLAR, KELLY MARGUERITE (LMSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARGUERITE
Last Name:MILLAR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MARGUERITE
Other - Last Name:KITCHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1275 GRANGER RD
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48462-9223
Mailing Address - Country:US
Mailing Address - Phone:810-407-2014
Mailing Address - Fax:
Practice Address - Street 1:1275 GRANGER RD
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MI
Practice Address - Zip Code:48462-9223
Practice Address - Country:US
Practice Address - Phone:810-407-2014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010956001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical