Provider Demographics
NPI:1760880496
Name:MARCUS, KELLI MARIE (LLPC)
Entity Type:Individual
Prefix:MS
First Name:KELLI
Middle Name:MARIE
Last Name:MARCUS
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 S BLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2969
Mailing Address - Country:US
Mailing Address - Phone:248-797-8807
Mailing Address - Fax:
Practice Address - Street 1:123 S BLAIR AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2969
Practice Address - Country:US
Practice Address - Phone:248-797-8807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other