Provider Demographics
NPI:1265997894
Name:BURKE-MICEK, CHELSEA MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:MARIE
Last Name:BURKE-MICEK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35300 NANKIN BLVD STE 601
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-7222
Mailing Address - Country:US
Mailing Address - Phone:888-355-5433
Mailing Address - Fax:
Practice Address - Street 1:35300 NANKIN BLVD STE 601
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-7222
Practice Address - Country:US
Practice Address - Phone:888-355-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
19-77683106S00000X
MI6801116754104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician