Individual
KELLY VAN MOEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LLPC
Contact information
Practice address
124 W GATES ST, SUITE 103, BRUCE TWP, MI 48065-4494
(586) 752-6969
Mailing address
124 W GATES ST, SUITE 103, BRUCE TWP, MI 48065-4494
(586) 752-6969
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
6401015525
MI
101YM0800X
Mental Health Counselor
Primary
6401015525
MI
Other
Enumeration date
07/12/2016
Last updated
07/12/2016
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