Provider Demographics
NPI:1508588617
Name:MCGILLIS, CHELSEY KAITLYN
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:KAITLYN
Last Name:MCGILLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHELSEY
Other - Middle Name:KAITLYN
Other - Last Name:BELCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TLLP
Mailing Address - Street 1:3300 E DEERFIELD RD APT B368
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-4591
Mailing Address - Country:US
Mailing Address - Phone:859-559-9692
Mailing Address - Fax:
Practice Address - Street 1:301 S CRAPO ST STE 200
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2941
Practice Address - Country:US
Practice Address - Phone:989-772-5938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6352000617103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist