Provider Demographics
NPI:1023321403
Name:SEELY, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SEELY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 NEW HAMPSHIRE ST
Mailing Address - Street 2:STE 222
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2736
Mailing Address - Country:US
Mailing Address - Phone:785-856-8218
Mailing Address - Fax:
Practice Address - Street 1:730 NEW HAMPSHIRE ST
Practice Address - Street 2:STE 222
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2736
Practice Address - Country:US
Practice Address - Phone:785-856-8218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
KS2224103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health