Provider Demographics
NPI:1275314270
Name:HADIX, KASSIDY L (TLLP)
Entity Type:Individual
Prefix:
First Name:KASSIDY
Middle Name:L
Last Name:HADIX
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 S QUARTERLINE RD APT 511
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-7907
Mailing Address - Country:US
Mailing Address - Phone:231-622-1591
Mailing Address - Fax:
Practice Address - Street 1:1475 ROBBINS RD STE 150
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-3700
Practice Address - Country:US
Practice Address - Phone:616-315-9605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009855103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist