Provider Demographics
NPI:1962538058
Name:KUSHLER, CHARLENE CRICKON (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:CRICKON
Last Name:KUSHLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1751 BROOKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48895-9372
Mailing Address - Country:US
Mailing Address - Phone:517-655-3738
Mailing Address - Fax:517-655-3738
Practice Address - Street 1:1751 BROOKSHIRE CT
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:MI
Practice Address - Zip Code:48895-9372
Practice Address - Country:US
Practice Address - Phone:517-655-3738
Practice Address - Fax:517-655-3738
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006384103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service