Provider Demographics
NPI:1457713786
Name:BASINGER, KERRY (LMFT)
Entity type:Individual
Prefix:MR
First Name:KERRY
Middle Name:
Last Name:BASINGER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18600 NORTHVILLE RD STE 400A
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-3544
Mailing Address - Country:US
Mailing Address - Phone:734-234-6688
Mailing Address - Fax:
Practice Address - Street 1:18600 NORTHVILLE RD STE 400A
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-3544
Practice Address - Country:US
Practice Address - Phone:734-234-6688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-25
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4101006803Medicaid