Provider Demographics
NPI:1891178430
Name:KELCH, MELISSA (LPC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:KELCH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42815 GARFIELD RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1143
Mailing Address - Country:US
Mailing Address - Phone:248-568-1849
Mailing Address - Fax:586-408-6485
Practice Address - Street 1:42815 GARFIELD RD
Practice Address - Street 2:SUITE 210
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1143
Practice Address - Country:US
Practice Address - Phone:248-568-1849
Practice Address - Fax:586-408-6485
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011631101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional