Provider Demographics
NPI:1467122531
Name:PUCKETT, SILKYA DENAI
Entity Type:Individual
Prefix:
First Name:SILKYA
Middle Name:DENAI
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S CRAWFORD RD APT E13
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-9353
Mailing Address - Country:US
Mailing Address - Phone:734-330-1082
Mailing Address - Fax:
Practice Address - Street 1:741 RICHARD DR
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:MI
Practice Address - Zip Code:48625-9289
Practice Address - Country:US
Practice Address - Phone:989-402-4072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451019685101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional