Healthcare Provider Details

I. General information

NPI: 1790736247
Provider Name (Legal Business Name): MARIE ANNETTE MCKAY PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1362 BALDWIN ST
JENISON MI
49428-8937
US

IV. Provider business mailing address

1362 BALDWIN ST
JENISON MI
49428-8937
US

V. Phone/Fax

Practice location:
  • Phone: 616-901-3635
  • Fax:
Mailing address:
  • Phone: 616-901-3635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301006599
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: