Provider Demographics
NPI:1912102526
Name:SEEL, KENNETH L (CADC, LLMFT)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:L
Last Name:SEEL
Suffix:
Gender:M
Credentials:CADC, LLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2168
Mailing Address - Country:US
Mailing Address - Phone:925-818-4419
Mailing Address - Fax:
Practice Address - Street 1:409 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2168
Practice Address - Country:US
Practice Address - Phone:925-818-4419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAS0606201414101YA0400X
MI4101006510106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist