Healthcare Provider Details

I. General information

NPI: 1346823879
Provider Name (Legal Business Name): MIKALA MARIE SELICH MA PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1286 S LINDEN RD
FLINT MI
48532-3457
US

IV. Provider business mailing address

1286 S LINDEN RD
FLINT MI
48532-3457
US

V. Phone/Fax

Practice location:
  • Phone: 810-407-7403
  • Fax:
Mailing address:
  • Phone: 517-657-2638
  • Fax: 248-712-4381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6362009782
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: