Provider Demographics
NPI:1841613957
Name:MESSING-MIRABITO, KELLY (LPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MESSING-MIRABITO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:MESSING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1532 BIGGERS RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1612
Mailing Address - Country:US
Mailing Address - Phone:248-981-7981
Mailing Address - Fax:
Practice Address - Street 1:800 STEPHENSON HWY
Practice Address - Street 2:SUITE 250
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1123
Practice Address - Country:US
Practice Address - Phone:248-585-3239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-00017101YA0400X
MI6401007561101YP2500X
MISC0000169101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool