Provider Demographics
NPI:1952452807
Name:SHIRLEY, KAYE (LPC)
Entity Type:Individual
Prefix:
First Name:KAYE
Middle Name:
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E GAYLORD ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3532
Mailing Address - Country:US
Mailing Address - Phone:989-753-8446
Mailing Address - Fax:989-753-8446
Practice Address - Street 1:118 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2513
Practice Address - Country:US
Practice Address - Phone:989-773-9328
Practice Address - Fax:989-773-9803
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009010101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional