Individual
KELLY LYNN BRANCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., LPC, LLMFT
Contact information
Practice address
901 EASTERN AVE NE, GRAND RAPIDS, MI 49503-1201
(616) 299-4305
Mailing address
8488 TUCKER CT, JENISON, MI 49428-8678
(616) 299-4305
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401012214
MI
106H00000X
Marriage & Family Therapist
4101006468
MI
Other
Enumeration date
09/06/2013
Last updated
09/06/2013
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