Provider Demographics
NPI:1780424820
Name:STEYAERT, KELLY (MA LLP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:STEYAERT
Suffix:
Gender:F
Credentials:MA LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1469 OAK ST
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-5525
Mailing Address - Country:US
Mailing Address - Phone:734-968-9050
Mailing Address - Fax:
Practice Address - Street 1:1469 OAK ST
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-5525
Practice Address - Country:US
Practice Address - Phone:734-968-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361007991103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist