Healthcare Provider Details

I. General information

NPI: 1801943162
Provider Name (Legal Business Name): KATHY SAMIR CHEBLI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 05/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S WAVERLY RD STE 4
LANSING MI
48917-3632
US

IV. Provider business mailing address

5022 RIFLE RIVER TRL
ALGER MI
48610-9327
US

V. Phone/Fax

Practice location:
  • Phone: 517-708-8215
  • Fax: 517-708-8223
Mailing address:
  • Phone: 989-516-4317
  • Fax: 989-345-5803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801085790
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: