Provider Demographics
NPI:1053795062
Name:PARTIDA KELLY, CELIA (MA,LPC,CAADC,CTP,EMD)
Entity type:Individual
Prefix:
First Name:CELIA
Middle Name:
Last Name:PARTIDA KELLY
Suffix:
Gender:F
Credentials:MA,LPC,CAADC,CTP,EMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 M 66 N
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-9338
Mailing Address - Country:US
Mailing Address - Phone:231-547-1144
Mailing Address - Fax:231-547-4970
Practice Address - Street 1:101 M 66 N
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-9338
Practice Address - Country:US
Practice Address - Phone:231-547-1144
Practice Address - Fax:231-547-4970
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803063798104100000X
MI6401014750101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383SYS0617OtherHUMANA BEHAVIORAL HEALTH
MIMIS601220443OtherMAGELLAN HEALTHCARE
MIMHPC20131030OtherMCLAREN HEALTH PLAN, MCLAREN MEDICAID, MCLAREN HMO, MCLAREN HEALTH ADVANTAGE
MI20151209439760Medicaid
MICOUN18-99599OtherMICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES
MIOA50081OtherBCBSM MENTAL HEALTH & SUBSTANCE ABUSE (65), PPO TRUST (55), TRADITIONAL (10) PAR