Provider Demographics
NPI:1982983383
Name:ESCHENBURG, KELLY LYNN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LYNN
Last Name:ESCHENBURG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LYNN
Other - Last Name:BUTKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:6249 RIVERTON DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-1879
Mailing Address - Country:US
Mailing Address - Phone:586-601-8277
Mailing Address - Fax:
Practice Address - Street 1:625 EAST BIG BEAVER ROAD
Practice Address - Street 2:SUITE #200
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083
Practice Address - Country:US
Practice Address - Phone:586-863-4000
Practice Address - Fax:586-863-4004
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010853181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical