Healthcare Provider Details

I. General information

NPI: 1053198010
Provider Name (Legal Business Name): KELSEY MARGARET SHAY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 TOWN CTR STE 1400
SOUTHFIELD MI
48075-1271
US

IV. Provider business mailing address

3000 TOWN CTR STE 1400
SOUTHFIELD MI
48075-1271
US

V. Phone/Fax

Practice location:
  • Phone: 866-287-1802
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1142683
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801122159
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: