MEDICARE: JUSTINE SEELEY

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	1041C0700X	Clinical Social Worker	6801117593

General Provider Information

NPI Number	:	1922666999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTINE SEELEY

Provider Business Mailing Address
First Line	:	17100 SILVER PKWY STE D
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-3468
Country	:	US
Telephone Number	:	810-208-0378
Fax Number	:

Provider Business Practice Location Address
First Line	:	17100 SILVER PKWY STE D
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-3468
Country	:	US
Telephone Number	:	810-208-0378
Fax Number	:	810-963-1917

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

Provider Enumeration Date	:	06/04/2019
Last Update Date	:	08/07/2025

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Directions to “ JUSTINE SEELEY ” Practice Location

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