Provider Demographics
NPI:1588997639
Name:TATARELLI-MULLINS, KELLY (LMSW, PSYD, LLP)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:TATARELLI-MULLINS
Suffix:
Gender:F
Credentials:LMSW, PSYD, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 WASHTENAW AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4200
Mailing Address - Country:US
Mailing Address - Phone:734-677-0200
Mailing Address - Fax:734-677-3310
Practice Address - Street 1:3300 WASHTENAW AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4200
Practice Address - Country:US
Practice Address - Phone:734-677-0200
Practice Address - Fax:734-677-3310
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIT364465261964101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)