Basic Information
| Provider Information | |||||||||
| NPI: | 1821606112 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRADETTE | ||||||||
| FirstName: | TAMI | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | LLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4730 CARLISLE HWY | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488138502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179802128 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5123 W ST JOE HWY STE 103 | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489174028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173234099 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2020 | ||||||||
| LastUpdateDate: | 07/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6401018475 | MI | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.