Healthcare Provider Details

I. General information

NPI: 1780374355
Provider Name (Legal Business Name): KYLE BABCOCK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 N SAGINAW RD
MIDLAND MI
48640-2301
US

IV. Provider business mailing address

3600 N SAGINAW RD
MIDLAND MI
48640-2301
US

V. Phone/Fax

Practice location:
  • Phone: 989-510-7626
  • Fax:
Mailing address:
  • Phone: 989-510-7626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451025399
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: