Healthcare Provider Details

I. General information

NPI: 1679434328
Provider Name (Legal Business Name): MIKAELA PARISH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 PORTAGE ST
KALAMAZOO MI
49001-3836
US

IV. Provider business mailing address

418 W KALAMAZOO AVE
KALAMAZOO MI
49007-3334
US

V. Phone/Fax

Practice location:
  • Phone: 269-993-0956
  • Fax:
Mailing address:
  • Phone: 269-993-0956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451025103
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: