MEDICARE: DR. MARIE ANNETTE MCKAY PSY.D.

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	103TC0700X	Clinical Psychologist	6301006599	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0G04523	OTHER	MI	BLUE CROSS/BLUE SHIELD MI

General Provider Information

NPI Number	:	1790736247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIE ANNETTE MCKAY PSY.D.

Provider Business Mailing Address
First Line	:	1362 BALDWIN ST
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49428-8937
Country	:	US
Telephone Number	:	616-901-3635
Fax Number	:

Provider Business Practice Location Address
First Line	:	1362 BALDWIN ST
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49428-8937
Country	:	US
Telephone Number	:	616-901-3635
Fax Number	:

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	05/21/2024

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