Provider Demographics
NPI:1811159841
Name:KELLY, CATHLEEN M (MA, LLPC)
Entity type:Individual
Prefix:MRS
First Name:CATHLEEN
Middle Name:M
Last Name:KELLY
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 ARBROAK CT
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-2580
Mailing Address - Country:US
Mailing Address - Phone:248-892-8410
Mailing Address - Fax:
Practice Address - Street 1:1145 ARBROAK CT
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-2580
Practice Address - Country:US
Practice Address - Phone:248-892-8410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009862101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor