Provider Demographics
NPI:1699875369
Name:TAIT, KATHLEEN A (MA, LPC, CRT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:TAIT
Suffix:
Gender:F
Credentials:MA, LPC, CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 E SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-5519
Mailing Address - Country:US
Mailing Address - Phone:517-487-9642
Mailing Address - Fax:517-487-1129
Practice Address - Street 1:5030 NORTHWIND DR STE 108
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5034
Practice Address - Country:US
Practice Address - Phone:517-336-4335
Practice Address - Fax:517-336-0101
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002812101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional