KELLY D DISTELRATH LLP
NPI 1598976375
Psychologist - Clinical in Port Huron, MI

Q: What is Kelly Distelrath's NPI number?

The NPI number for Kelly Distelrath is 1598976375. It was assigned to this individual provider in the NPPES registry on May 24, 2007. The provider is also known as Kelly D Hadden.

Q: What is Kelly Distelrath's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: When was this NPI record last updated?

The NPPES record for Kelly Distelrath was last updated on March 3, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 24, 2007

520 SUPERIOR ST, PORT HURON, MI 48060(810) 984-4202 Get Directions Write a Review

NPPES record last updated: March 3, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

On this page

About Kelly D Distelrath Llp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY D DISTELRATH LLP (NPI 1598976375) is an individual clinical provider in Port Huron, Michigan, licensed in Michigan (6361007549) and active in the NPI registry since May 2007. She maintains a secondary practice location in Warren.

NPPES Registry Identity

NPI1598976375

Entity TypeIndividualFemale

Primary Taxonomy103TC0700X

Provider Legal NameKELLY D DISTELRATHCredential: LLP

Location Address520 SUPERIOR STPort Huron, MI 48060-3838

Mailing Address1340 Pinecrest DrFerndale, MI 48220-1608 · (586) 258-0206 · Fax (586) 258-0201

Phone(810) 984-4202

Sole ProprietorNo

Enumeration DateMay 24, 2007

Last NPPES UpdateMarch 3, 2021

NPPES CertifiedMarch 3, 2021

✔ NPI 1598976375 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in MI · 6361007549

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

Also ListedCounselor · Mental HealthTaxonomy 101YM0800X

520 SUPERIOR ST, Port Huron, MI 48060

Open in Google Maps ↗

Other Names 1

Former Name (1)Kelly D Hadden

Secondary Practice Location 1

Location 112220 E 13 Mile Rd, Suite 300Warren, MI 48093-5000 · Phone (586) 258-0206 ext. 119 · Fax (586) 258-0201

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company, Priority Health.Insurance ›

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SARA M TAVORA LMSW

Social Worker (Clinical)