Provider Demographics
NPI:1245510601
Name:WATKINS, KELLI ANN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:ANN
Last Name:WATKINS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:KELLI
Other - Middle Name:ANN
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:136 E MAUMEE ST STE 8
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-2724
Mailing Address - Country:US
Mailing Address - Phone:517-438-8144
Mailing Address - Fax:517-438-8195
Practice Address - Street 1:136 E MAUMEE ST STE 8
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2724
Practice Address - Country:US
Practice Address - Phone:517-438-8144
Practice Address - Fax:517-438-8195
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010929631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical