Individual
MS. MICHELLE MARIE KELLUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
11400 JULIANNE AVE N, STILLWATER, MN 55082-9436
(651) 426-3300
(651) 426-0419
Mailing address
11400 JULIANNE AVE N, STILLWATER, MN 55082-9436
(651) 426-3300
(651) 426-0419
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
301823
MN
Other
Enumeration date
05/16/2011
Last updated
05/16/2011
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