Provider Demographics
NPI:1649360769
Name:RAAB-BUTLER, KELLEY MICHEL (LMSW)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:MICHEL
Last Name:RAAB-BUTLER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2303
Mailing Address - Country:US
Mailing Address - Phone:231-580-9585
Mailing Address - Fax:989-546-8550
Practice Address - Street 1:207 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2303
Practice Address - Country:US
Practice Address - Phone:989-824-2374
Practice Address - Fax:989-546-8550
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010879041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI842671510Medicaid
MI14229139OtherCAQH