Provider Demographics
NPI:1770082018
Name:KELLY, AMY DANIELLE (LPC, QMHP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:DANIELLE
Last Name:KELLY
Suffix:
Gender:F
Credentials:LPC, QMHP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:DANIELLE
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11667 CHAREST ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3026
Mailing Address - Country:US
Mailing Address - Phone:313-442-6272
Mailing Address - Fax:
Practice Address - Street 1:323 N STATE ST
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-1537
Practice Address - Country:US
Practice Address - Phone:989-673-6191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator