Healthcare Provider Details

I. General information

NPI: 1619891710
Provider Name (Legal Business Name): MS. KASEY MAE MIX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 SEMINOLE RD STE 210
NORTON SHORES MI
49444-3743
US

IV. Provider business mailing address

402 FARR RD
NORTON SHORES MI
49444-9788
US

V. Phone/Fax

Practice location:
  • Phone: 231-888-2250
  • Fax:
Mailing address:
  • Phone: 231-563-0445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: