Provider Demographics
NPI:1851777973
Name:KINSEY, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KINSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26813 PARK LN
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-4384
Mailing Address - Country:US
Mailing Address - Phone:734-777-6375
Mailing Address - Fax:
Practice Address - Street 1:26813 PARK LN
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-4384
Practice Address - Country:US
Practice Address - Phone:734-777-6375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70915101Y00000X
MI6401014849101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor