Provider Demographics
NPI:1245360924
Name:JAGERS, KELLY ANN MCGINITY (LMSW LMFT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN MCGINITY
Last Name:JAGERS
Suffix:
Gender:F
Credentials:LMSW LMFT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:M
Other - Last Name:JAGERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW ACSW LMFT
Mailing Address - Street 1:1785 PARAMOUNT
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377
Mailing Address - Country:US
Mailing Address - Phone:248-477-5200
Mailing Address - Fax:248-960-2271
Practice Address - Street 1:1785 PARAMOUNT
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377
Practice Address - Country:US
Practice Address - Phone:248-477-5200
Practice Address - Fax:248-960-2271
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILMFT 4101005546106H00000X
MILMSW 6801035225104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
098818OtherMANAGED HEALTH NETWORK
171340OtherVALUE OPTIONS
109507000OtherMAGELLAN
MIOP11910Medicare ID - Type Unspecified
171340OtherVALUE OPTIONS