Provider Demographics
NPI:1104655968
Name:CORRELL, KRISTY LYNN (MSW)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNN
Last Name:CORRELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3391 FLORETTA ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-4013
Mailing Address - Country:US
Mailing Address - Phone:248-622-3783
Mailing Address - Fax:
Practice Address - Street 1:204 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2070
Practice Address - Country:US
Practice Address - Phone:734-992-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010936711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical