Healthcare Provider Details

I. General information

NPI: 1013253715
Provider Name (Legal Business Name): MICHAEL ZITO II M.A., LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2012
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 NORTH STREET SUITE 110
KALAMAZOO MI
49009
US

IV. Provider business mailing address

10150 PORTAGE RD
PORTAGE MI
49002-7281
US

V. Phone/Fax

Practice location:
  • Phone: 269-375-4363
  • Fax: 269-375-4362
Mailing address:
  • Phone: 269-532-2223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6401013329
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: