Provider Demographics
NPI:1306221171
Name:BELL, KEISHA LYNETTE (MS)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:LYNETTE
Last Name:BELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1620
Mailing Address - Country:US
Mailing Address - Phone:313-656-4052
Mailing Address - Fax:313-656-4053
Practice Address - Street 1:194 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1620
Practice Address - Country:US
Practice Address - Phone:313-656-4052
Practice Address - Fax:313-656-4053
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22282103T00000X
MI6301016270103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist