MEDICARE: MICHAEL SEELY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	103TC0700X	Clinical Psychologist	2224	KS

General Provider Information

NPI Number	:	1023321403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL SEELY

Provider Business Mailing Address
First Line	:	730 NEW HAMPSHIRE ST
Second Line	:	STE 222
City	:	LAWRENCE
State	:	KS
Zip	:	66044-2736
Country	:	US
Telephone Number	:	785-856-8218
Fax Number	:

Provider Business Practice Location Address
First Line	:	730 NEW HAMPSHIRE ST
Second Line	:	STE 222
City	:	LAWRENCE
State	:	KS
Zip	:	66044-2736
Country	:	US
Telephone Number	:	785-856-8218
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2010
Last Update Date	:	08/19/2015

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