Provider Demographics
NPI:1104849850
Name:SEELEY, MICHAEL B (MSW, LCSW, CADC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:SEELEY
Suffix:
Gender:M
Credentials:MSW, LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 N JANACEK RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-6102
Mailing Address - Country:US
Mailing Address - Phone:262-641-9050
Mailing Address - Fax:262-641-9126
Practice Address - Street 1:8200 W BROWN DEER RD
Practice Address - Street 2:SUITE 300A
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53223-1706
Practice Address - Country:US
Practice Address - Phone:414-362-8147
Practice Address - Fax:414-362-7198
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI295-1231041C0700X
WI12688-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39591900Medicaid
WI39591900Medicaid