Provider Demographics
NPI:1679997464
Name:JUSHAK, MICHAEL ANDREW (LMSW, CAADC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANDREW
Last Name:JUSHAK
Suffix:
Gender:M
Credentials:LMSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1975
Mailing Address - Country:US
Mailing Address - Phone:248-529-6383
Mailing Address - Fax:
Practice Address - Street 1:120 SOUTH MAIN STREET
Practice Address - Street 2:SUITE C
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381
Practice Address - Country:US
Practice Address - Phone:248-529-6383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010960711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical