Provider Demographics
NPI:1063816726
Name:KELLEY, JESSICA (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:NOVETSKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:3615 VANCE RD
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-8512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3301 VETERANS DR STE 205
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4575
Practice Address - Country:US
Practice Address - Phone:231-714-4532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-09
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401019150101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor