Individual
MS. SHARON KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LLP, CAAC
Contact information
Practice address
210 S MAIN ST, THREE RIVERS, MI 49093-1624
(269) 273-5000
(269) 273-8019
Mailing address
677A EAST MAIN, CENTREVILLE, MI 49032
(269) 467-1000
(269) 467-3075
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301004068
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1708146
—
MI
01
—
P10G510150
BCBS
MI
Enumeration date
09/27/2005
Last updated
07/17/2009
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