Provider Demographics
NPI:1225364953
Name:MCKENTRY, CARMEL ELAISE (MA/LPC)
Entity Type:Individual
Prefix:
First Name:CARMEL
Middle Name:ELAISE
Last Name:MCKENTRY
Suffix:
Gender:F
Credentials:MA/LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 W WALTON AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49440-1360
Mailing Address - Country:US
Mailing Address - Phone:231-722-7980
Mailing Address - Fax:231-722-7979
Practice Address - Street 1:8 W WALTON AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49440-1360
Practice Address - Country:US
Practice Address - Phone:231-722-7980
Practice Address - Fax:231-722-7979
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-31
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1225364953101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional