1467911024 NPI number — MRS. KAITLYNN RAYE MORELLI LPC

Table of content: MRS. KAITLYNN RAYE MORELLI LPC (NPI 1467911024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467911024 NPI number — MRS. KAITLYNN RAYE MORELLI LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORELLI
Provider First Name:
KAITLYNN
Provider Middle Name:
RAYE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SINKE
Provider Other First Name:
KAITLYNN
Provider Other Middle Name:
RAYE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467911024
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45073 ELMHURST CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHELBY TOWNSHIP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48317-4986
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-599-5866
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15300 21 MILE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACOMB
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48044-5024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-599-5866
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  6401015480 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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