Provider Demographics
NPI:1437593324
Name:WYSS, KATIE MILLIS (LMSW)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MILLIS
Last Name:WYSS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 SHILOH DR
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-9053
Mailing Address - Country:US
Mailing Address - Phone:734-926-9189
Mailing Address - Fax:
Practice Address - Street 1:218 N 4TH AVE STE 207
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1472
Practice Address - Country:US
Practice Address - Phone:734-926-9189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010952741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical