Provider Demographics
NPI:1063109148
Name:HUGHES, KELLY WRAY (LLMSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:WRAY
Last Name:HUGHES
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 WIENEKE RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2600
Mailing Address - Country:US
Mailing Address - Phone:989-262-7385
Mailing Address - Fax:
Practice Address - Street 1:1349 S OTSEGO AVE STE 11
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-9170
Practice Address - Country:US
Practice Address - Phone:989-448-8540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851115398104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker