Provider Demographics
NPI:1760776249
Name:KIPPE, KELLI A (MA, LPC, CAADC, CCS)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:A
Last Name:KIPPE
Suffix:
Gender:F
Credentials:MA, LPC, CAADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1282 S M 66 HWY
Mailing Address - Street 2:
Mailing Address - City:MANCELONA
Mailing Address - State:MI
Mailing Address - Zip Code:49659-8778
Mailing Address - Country:US
Mailing Address - Phone:231-622-2122
Mailing Address - Fax:
Practice Address - Street 1:205 E CAYUGA ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:MI
Practice Address - Zip Code:49615-9180
Practice Address - Country:US
Practice Address - Phone:231-622-2122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012482101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor