Provider Demographics
NPI:1447588363
Name:MICHAUD, KELLY M (LPC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:MICHAUD
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:A
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:345 W MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-2413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:345 W MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-2413
Practice Address - Country:US
Practice Address - Phone:912-456-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-04
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA12610067OtherCAQH
GA003141299AMedicaid