Provider Demographics
NPI:1568829505
Name:SEVERT, KERI L (LPC BCBA)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:L
Last Name:SEVERT
Suffix:
Gender:F
Credentials:LPC BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6556 OLD ELMWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CASS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48726-8917
Mailing Address - Country:US
Mailing Address - Phone:989-551-5653
Mailing Address - Fax:
Practice Address - Street 1:6556 OLD ELMWOOD RD
Practice Address - Street 2:
Practice Address - City:CASS CITY
Practice Address - State:MI
Practice Address - Zip Code:48726-8917
Practice Address - Country:US
Practice Address - Phone:989-551-5653
Practice Address - Fax:989-551-5653
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
MI6401012282101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional