Individual
GERALD MICKETTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LLPC
Contact information
Practice address
1200 W. 11TH STREET, SUITE 111, TRAVERSE CITY, MI 49684-3288
(231) 499-8290
Mailing address
1200 W 11TH ST STE 111, TRAVERSE CITY, MI 49684-3288
(231) 499-8290
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401012457
MI
Other
Enumeration date
02/03/2015
Last updated
02/23/2015
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