Healthcare Provider Details

I. General information

NPI: 1871193821
Provider Name (Legal Business Name): SHYLA SEMAJ LIPSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2020
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HOWARD ST
KALAMAZOO MI
49001-2748
US

IV. Provider business mailing address

401 HOWARD ST
KALAMAZOO MI
49001-2748
US

V. Phone/Fax

Practice location:
  • Phone: 269-344-4458
  • Fax:
Mailing address:
  • Phone: 269-344-4458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801110597
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: