Provider Demographics
NPI:1598179616
Name:KELLEY, ARTHUR II
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:
Last Name:KELLEY
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15819 SCHOOLCRAFT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-1749
Mailing Address - Country:US
Mailing Address - Phone:313-493-4900
Mailing Address - Fax:313-493-4904
Practice Address - Street 1:15819 SCHOOLCRAFT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-1749
Practice Address - Country:US
Practice Address - Phone:313-493-4900
Practice Address - Fax:313-493-4904
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010908411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical