Individual
MISS KELLY JEAN MAHLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LLP, PTA
Contact information
Practice address
55753 SERENE DR, MACOMB, MI 48042-6164
(586) 216-3815
Mailing address
55753 SERENE DR, MACOMB, MI 48042-6164
(586) 216-3815
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
6301013552
MI
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
05/23/2007
Last updated
11/19/2012
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