Provider Demographics
NPI:1831296573
Name:MCKINZIE, SHER (LLP)
Entity Type:Individual
Prefix:MS
First Name:SHER
Middle Name:
Last Name:MCKINZIE
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24865 5 MILE RD
Mailing Address - Street 2:STE 4
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-3694
Mailing Address - Country:US
Mailing Address - Phone:313-533-1550
Mailing Address - Fax:313-533-1456
Practice Address - Street 1:24865 5 MILE RD
Practice Address - Street 2:STE 4
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3694
Practice Address - Country:US
Practice Address - Phone:313-533-1550
Practice Address - Fax:313-533-1456
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012264103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling