Provider Demographics
NPI:1528216173
Name:WELLER, KELLI ANN (LPC)
Entity Type:Individual
Prefix:MS
First Name:KELLI
Middle Name:ANN
Last Name:WELLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25600 WOODWARD AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-0943
Mailing Address - Country:US
Mailing Address - Phone:248-399-7447
Mailing Address - Fax:248-399-7447
Practice Address - Street 1:25600 WOODWARD AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-0943
Practice Address - Country:US
Practice Address - Phone:248-399-7447
Practice Address - Fax:248-399-7447
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011025101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional