Kelly Mack

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

6451023685 Issued in MI

Practice address

2301 S Huron Pkwy Ste 3D
Ann Arbor, MI 48104-5133

Phone

(734) 719-0197

NPI assigned

Jul 23, 2024

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 23, 2024.

{
    "created_epoch": "1721692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721692800000",
    "number": "1992533830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14800 E OLD US HIGHWAY 12",
            "city": "CHELSEA",
            "state": "MI",
            "postal_code": "481182110",
            "telephone_number": "734-719-0380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 S HURON PKWY STE 3D",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481045133",
            "telephone_number": "734-719-0197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "KELLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-23",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MI",
            "license": "6451023685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Joseph Maciejewski, M.D.
• Laurie Ann Mack-Cockerill, OTR
• Jacob Andrew Mack, MD
• Jaquel Mack
• Jesse Mack
• Megan Rose Mack, M.D.
• Heather Mary Mackenzie, LMSW
• Jacob John Mackenzie, PA-C
• Kathleen Chamisa Mackenzie, MSW
• Ryan Michael Mackenzie, NP

• All providers in Ann Arbor, MI
• Mental Health Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.