Provider Demographics
NPI:1689703357
Name:PAVEL, KELLY JO (MA, LLPC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:JO
Last Name:PAVEL
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6949 CADE RD
Mailing Address - Street 2:
Mailing Address - City:BROWN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48416-9165
Mailing Address - Country:US
Mailing Address - Phone:810-346-2271
Mailing Address - Fax:
Practice Address - Street 1:6949 CADE RD
Practice Address - Street 2:
Practice Address - City:BROWN CITY
Practice Address - State:MI
Practice Address - Zip Code:48416-9165
Practice Address - Country:US
Practice Address - Phone:810-346-2271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL916733101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional