Healthcare Provider Details

I. General information

NPI: 1942414941
Provider Name (Legal Business Name): CATHERINE D MCKAY M.A. L.L.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HASTINGS ST
TRAVERSE CITY MI
49686-3445
US

IV. Provider business mailing address

609 S BAYSHORE DR
ELK RAPIDS MI
49629-9732
US

V. Phone/Fax

Practice location:
  • Phone: 231-947-8110
  • Fax: 231-947-3522
Mailing address:
  • Phone: 231-590-0332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number6301005190
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: