Provider Demographics
NPI:1225887789
Name:DR. MARIE A MCKAY PLLC
Entity type:Organization
Organization Name:DR. MARIE A MCKAY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:616-901-3635
Mailing Address - Street 1:1551 CAPRICE DR
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-9582
Mailing Address - Country:US
Mailing Address - Phone:616-901-3635
Mailing Address - Fax:
Practice Address - Street 1:1362 BALDWIN ST
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-8937
Practice Address - Country:US
Practice Address - Phone:616-901-3635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)