Provider Demographics
NPI:1760223572
Name:SIGGERS, MYKAILAH C (MA, TMLP)
Entity type:Individual
Prefix:
First Name:MYKAILAH
Middle Name:C
Last Name:SIGGERS
Suffix:
Gender:F
Credentials:MA, TMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 SANGRIA ST SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49418-7345
Mailing Address - Country:US
Mailing Address - Phone:616-256-7792
Mailing Address - Fax:
Practice Address - Street 1:2650 HORIZON DR SE STE 225
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7962
Practice Address - Country:US
Practice Address - Phone:616-264-5414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009830103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling