Individual
CARLA JEAN KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, LLPC
Contact information
Practice address
800 E MILHAM AVE, PORTAGE, MI 49002-1490
(269) 249-7179
Mailing address
6752 PLEASANTVIEW DR, PORTAGE, MI 49024-1004
(269) 352-1857
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401004965
MI
Other
Enumeration date
01/02/2022
Last updated
01/02/2022
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