Provider Demographics
NPI:1821606112
Name:FRADETTE, TAMI KAY (LLPC)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:KAY
Last Name:FRADETTE
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 CARLISLE HWY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-8502
Mailing Address - Country:US
Mailing Address - Phone:517-980-2128
Mailing Address - Fax:
Practice Address - Street 1:5123 W ST JOE HWY STE 103
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4028
Practice Address - Country:US
Practice Address - Phone:517-323-4099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018475101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor