Provider Demographics
NPI:1538751300
Name:MCLAUGHLIN, KELLY (MSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:MALLOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17400 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-5439
Practice Address - Country:US
Practice Address - Phone:248-712-4120
Practice Address - Fax:248-792-5243
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010892701041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical