Provider Demographics
NPI:1063958395
Name:KELLEY, BRIAN R (LMSW, CAADC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:R
Last Name:KELLEY
Suffix:
Gender:
Credentials:LMSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 HOLLOW OAK DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-8402
Mailing Address - Country:US
Mailing Address - Phone:646-660-3713
Mailing Address - Fax:
Practice Address - Street 1:202 E WASHINGTON ST STE 602
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2012
Practice Address - Country:US
Practice Address - Phone:646-660-3713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011121171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical