Healthcare Provider Details

I. General information

NPI: 1962020867
Provider Name (Legal Business Name): MANDI WITHEY, MS, LLP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 04/28/2024
Certification Date: 04/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8240 EMBURY RD
GRAND BLANC MI
48439-7113
US

IV. Provider business mailing address

12745 S SAGINAW ST STE 806-112
GRAND BLANC MI
48439-2437
US

V. Phone/Fax

Practice location:
  • Phone: 616-894-2234
  • Fax:
Mailing address:
  • Phone: 616-894-2234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MANDI WITHEY
Title or Position: OWNER
Credential:
Phone: 616-894-2234