Provider Demographics
NPI:1053888446
Name:MINSHEW, KERRY ANNE (LPC)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:ANNE
Last Name:MINSHEW
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42283 HIGHGATE CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3523
Mailing Address - Country:US
Mailing Address - Phone:734-981-9081
Mailing Address - Fax:734-981-9081
Practice Address - Street 1:42283 HIGHGATE CT
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3523
Practice Address - Country:US
Practice Address - Phone:734-981-9081
Practice Address - Fax:734-981-9081
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014731101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor