Provider Demographics
NPI:1649697962
Name:SEELYE, JADE (LMSW)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:SEELYE
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 1:12124 W. LAKESHORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRIMLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49715
Mailing Address - Country:US
Mailing Address - Phone:906-248-8300
Mailing Address - Fax:906-248-3508
Practice Address - Street 1:12124 W. LAKESHORE DRIVE
Practice Address - Street 2:
Practice Address - City:BRIMLEY
Practice Address - State:MI
Practice Address - Zip Code:49715-9286
Practice Address - Country:US
Practice Address - Phone:906-248-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010958451041C0700X
MIL155020104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker