Provider Demographics
NPI:1841881257
Name:KAS-MIKHA, SELENA
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:KAS-MIKHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55038 TIMBERS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-6340
Mailing Address - Country:US
Mailing Address - Phone:586-604-5982
Mailing Address - Fax:
Practice Address - Street 1:8243 HALL RD STE 200
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5504
Practice Address - Country:US
Practice Address - Phone:586-933-5395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011088641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical