Provider Demographics
NPI:1750433363
Name:FERRIS, KATE MABLE (MSW LMSW)
Entity type:Individual
Prefix:MRS
First Name:KATE
Middle Name:MABLE
Last Name:FERRIS
Suffix:
Gender:F
Credentials:MSW LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42199 ANN ARBOR RD E
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4370
Mailing Address - Country:US
Mailing Address - Phone:734-584-7153
Mailing Address - Fax:
Practice Address - Street 1:42199 ANN ARBOR RD E
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4370
Practice Address - Country:US
Practice Address - Phone:734-425-0636
Practice Address - Fax:734-425-4771
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801066703101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Q26384056Medicare ID - Type Unspecified