Individual
CARLY LACELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1611 W CENTRE AVE STE 108, PORTAGE, MI 49024-5344
(269) 366-8858
Mailing address
1611 W CENTRE AVE STE 108, PORTAGE, MI 49024-5344
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6361007651
MI
103TC1900X
Counseling Psychologist
6301017883
MI
Other
Enumeration date
09/11/2019
Last updated
05/06/2026
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