Healthcare Provider Details

I. General information

NPI: 1285784736
Provider Name (Legal Business Name): KIMBERLY RAE KEISEL MA, LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS KIMBERLY RAE STAM

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 TUURI PL
FLINT MI
48503-2465
US

IV. Provider business mailing address

806 TUURI PLACE
FLINT MI
48503
US

V. Phone/Fax

Practice location:
  • Phone: 810-767-5750
  • Fax:
Mailing address:
  • Phone: 810-767-5750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401009294
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: