Provider Demographics
NPI:1871847053
Name:MCKELLAR, ANDREW DEMOTT (LMSW)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:DEMOTT
Last Name:MCKELLAR
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 NORTH MITCHELL STREET
Mailing Address - Street 2:DEPARTMENT OF VETERANS AFFAIRS - CADILLAC CBOC
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601
Mailing Address - Country:US
Mailing Address - Phone:231-775-4401
Mailing Address - Fax:231-775-4546
Practice Address - Street 1:1909 NORTH MITCHELL STREET
Practice Address - Street 2:DEPARTMENT OF VETERANS AFFAIRS - CADILLAC CBOC
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601
Practice Address - Country:US
Practice Address - Phone:231-775-4401
Practice Address - Fax:231-775-4546
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010462861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical