Provider Demographics
NPI:1518056860
Name:SEIDEL, KIM MICHELLE (MA, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:MICHELLE
Last Name:SEIDEL
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 NORTH DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3228
Mailing Address - Country:US
Mailing Address - Phone:989-621-9877
Mailing Address - Fax:
Practice Address - Street 1:110 E BROADWAY ST
Practice Address - Street 2:SUITE F
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2572
Practice Address - Country:US
Practice Address - Phone:989-621-9877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006502101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional