Provider Demographics
NPI:1497186381
Name:MUGETT, MICHAEL (LPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MUGETT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4123 OKEMOS RD
Mailing Address - Street 2:STE 14
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2818
Mailing Address - Country:US
Mailing Address - Phone:616-238-6206
Mailing Address - Fax:517-347-9622
Practice Address - Street 1:4123 OKEMOS RD
Practice Address - Street 2:STE 14
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2818
Practice Address - Country:US
Practice Address - Phone:616-238-6206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009279101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional