Provider Demographics
NPI:1285822270
Name:KLYM, MARY (ACSW,LMSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KLYM
Suffix:
Gender:F
Credentials:ACSW,LMSW
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:NELL
Other - Last Name:KLYM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ACSW,LMSW
Mailing Address - Street 1:9577 E WALKABOUT LN
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-6862
Mailing Address - Country:US
Mailing Address - Phone:231-935-6911
Mailing Address - Fax:231-935-6920
Practice Address - Street 1:1105 SIXTH ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2345
Practice Address - Country:US
Practice Address - Phone:231-935-6911
Practice Address - Fax:231-935-6920
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801035403101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor