Healthcare Provider Details

I. General information

NPI: 1760545131
Provider Name (Legal Business Name): PSYCHOLOGY ASSOCIATES OF THE KEWEENAW PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56730 CALUMET AVE SUITE F
CALUMET MI
49913-2968
US

IV. Provider business mailing address

56730 CALUMET AVE SUITE F
CALUMET MI
49913-2968
US

V. Phone/Fax

Practice location:
  • Phone: 906-337-6839
  • Fax: 906-337-0944
Mailing address:
  • Phone: 906-337-6839
  • Fax: 906-337-0944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ROBERT W SHARKEY
Title or Position: PRESIDENT
Credential: PHDLP
Phone: 906-337-6839