Healthcare Provider Details

I. General information

NPI: 1649720111
Provider Name (Legal Business Name): MELISSA RENEE KUZNAR MA, LPC, NT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2016
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18600 NORTHVILLE RD STE 400C
NORTHVILLE MI
48168-3544
US

IV. Provider business mailing address

37095 DICKINSON CT
FARMINGTON HILLS MI
48335-4818
US

V. Phone/Fax

Practice location:
  • Phone: 248-243-4386
  • Fax:
Mailing address:
  • Phone: 248-259-2382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberPF0000000882476
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401015602
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: