Healthcare Provider Details

I. General information

NPI: 1750781878
Provider Name (Legal Business Name): KAITLYN SHIELDS BUBLITZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLYN SHEILDS LPC

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8116 CLAYTON RD
HARBOR SPRINGS MI
49740-9571
US

IV. Provider business mailing address

8116 CLAYTON RD
HARBOR SPRINGS MI
49740-9571
US

V. Phone/Fax

Practice location:
  • Phone: 810-287-9275
  • Fax:
Mailing address:
  • Phone: 810-287-9275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401014427
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401014427
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: