Healthcare Provider Details

I. General information

NPI: 1518056860
Provider Name (Legal Business Name): KIM MICHELLE SEIDEL M.A., L.P.C., N.C.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 LAKE ST
CRYSTAL MI
48818-5141
US

IV. Provider business mailing address

1325 NORTH DR
MOUNT PLEASANT MI
48858-3228
US

V. Phone/Fax

Practice location:
  • Phone: 989-621-9877
  • Fax:
Mailing address:
  • Phone: 989-621-9877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401006502
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: