Individual
MRS. KELLY PINNEY ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC, BCPC
Contact information
Practice address
404 BROADWAY ST, SUITE B, SOUTH HAVEN, MI 49090-1421
(269) 214-1234
(269) 872-3625
Mailing address
404 BROADWAY ST, SUITE B, SOUTH HAVEN, MI 49090-1421
(269) 214-1234
(269) 872-3625
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401011487
MI
Other
Enumeration date
08/17/2009
Last updated
07/07/2015
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