Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | C.1300607 | OH |
Y | 101YP2500X | Professional Counselor | E.1300607 | OH |
N | 104100000X | Social Worker | S.0025386 | OH |
NPI | 1073934105 |
---|---|
Provider Name | Mrs. K. Michelle Kelly |
First Address | Wooster, OH 44691-9523 |
Second Address | Wooster, OH 44691-9523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2013 |
Last Update Date | 05/04/2016 |