Provider Demographics
NPI:1366192726
Name:DYE, KELLY MARIE (LMSW-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:DYE
Suffix:
Gender:F
Credentials:LMSW-C
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MARIE
Other - Last Name:DYE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW-C
Mailing Address - Street 1:465 S BEAR LAKE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-2797
Mailing Address - Country:US
Mailing Address - Phone:231-855-0210
Mailing Address - Fax:
Practice Address - Street 1:3088 SHEFFIELD ST STE A
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-4290
Practice Address - Country:US
Practice Address - Phone:231-737-1213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011140211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical