Provider Demographics
NPI:1285784736
Name:KEISEL, KIMBERLY RAE (MA, LLPC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:RAE
Last Name:KEISEL
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:RAE
Other - Last Name:STAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:806 TUURI PLACE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503
Mailing Address - Country:US
Mailing Address - Phone:810-767-5750
Mailing Address - Fax:
Practice Address - Street 1:806 TUURI PL
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2465
Practice Address - Country:US
Practice Address - Phone:810-767-5750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009294101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor