Organization
KELLY OTP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AARON DOUGLAS ALSTON (PRATICE ADMINISTRATOR)
(248) 971-0150
Entity
Organization
Contact information
Practice address
25200 KELLY RD, ROSEVILLE, MI 48066-4473
(586) 422-1250
Mailing address
7 RIVERBANK DR, BEVERLY HILLS, MI 48025-4800
(248) 971-0150
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
103TC1900X
Counseling Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
261QM2800X
Methadone Clinic
Primary
—
—
Other
Enumeration date
08/19/2022
Last updated
08/16/2023
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