Provider Demographics
NPI:1801943162
Name:CHEBLI, KATHY SAMIR (LMSW)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:SAMIR
Last Name:CHEBLI
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 1:5022 RIFLE RIVER TRL
Mailing Address - Street 2:
Mailing Address - City:ALGER
Mailing Address - State:MI
Mailing Address - Zip Code:48610-9327
Mailing Address - Country:US
Mailing Address - Phone:989-516-4317
Mailing Address - Fax:989-345-5803
Practice Address - Street 1:420 S WAVERLY RD
Practice Address - Street 2:STE 4
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-3632
Practice Address - Country:US
Practice Address - Phone:517-708-8215
Practice Address - Fax:517-708-8223
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010857901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1801943162Medicaid
MI1801943162Medicare PIN