Individual ProviderKelly QueenCounselorBehavioral Health & Social Service ProvidersPractice Address2825 Livernois Rd, Troy, MI 48083-1214(248) 680-2060PECOS EnrollmentBased on the most recent information from CMS, provider Kelly Queen is legally eligible to order and refer claims for Part B and DME services only.Part BMedicare Part BEnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1861590283Provider TypeIndividualFull NameQueen, KellyCredentialLPCGenderFemaleSole ProprietorNoEnumeration Date9/20/2006Last Updated4/3/2024Contact InformationPractice LocationPractice Address2825 Livernois Rd, Troy, MI 48083-1214Phone(248) 680-2060FaxUnlisted FaxMailing LocationMailing Address2825 Livernois Rd, Troy, MI 48083-1214Phone(248) 680-2060FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YP2500XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicense6401007827MichiganCode101Y00000XDescriptionCounselorBehavioral Health & Social Service ProvidersLicense6401007827Michigan