Provider Demographics
NPI:1679369961
Name:JO KELLY COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:JO KELLY COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JO
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MA LLC
Authorized Official - Phone:616-885-6027
Mailing Address - Street 1:5557 28TH ST SE STE B291
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-2025
Mailing Address - Country:US
Mailing Address - Phone:616-885-6027
Mailing Address - Fax:
Practice Address - Street 1:5557 28TH ST SE STE B291
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-2025
Practice Address - Country:US
Practice Address - Phone:616-885-6027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty