KELLY OTP LLC NPI 1265150767

NPI Information

NPI: 1265150767
Provider Name: KELLY OTP LLC
Classification: Clinic/Center - 261QM2800X
Entity Type: Organization

Specialization: Methadone

CLIA Number: 23D2275970

Address:
25200 KELLY RD
ROSEVILLE, MI
ZIP 48066
Phone: (586) 422-1250
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KELLY OTP LLC is a methadone clinic center in Roseville, MI. The provider is an entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. KELLY OTP LLC NPI is 1265150767. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

25200 KELLY RD
ROSEVILLE, MI
ZIP 48066-473
Phone: (586) 422-1250

The provider's authorized official is Aaron Douglas Alston .
The authorized official title is Pratice Administrator and has the following contact phone number (248) 971-0150.

The CLIA number assigned to this NPI record is 23D2275970 - other - opiod treatment with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/19/2022 and was last updated on 8/16/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	No
2	101YM0800X	Counselor	Mental Health	No
3	103TC1900X	Psychologist	Counseling	No
4	1041C0700X	Social Worker	Clinical	No
5	207QA0401X	Family Medicine	Addiction Medicine	No
6	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	No
7	261QM2500X	Clinic/Center	Medical Specialty	No
8	261QM2800X	Clinic/Center	Methadone	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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