Provider Demographics
NPI:1417690470
Name:MCKEE, MARY CAITLIN
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CAITLIN
Last Name:MCKEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6680 N WEST BAY SHORE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:MI
Mailing Address - Zip Code:49670-9425
Mailing Address - Country:US
Mailing Address - Phone:231-866-1905
Mailing Address - Fax:
Practice Address - Street 1:945 BARLOW ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-4250
Practice Address - Country:US
Practice Address - Phone:231-268-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician