Provider Demographics
NPI:1518028489
Name:LARKEY-GREEN, KATHY (LPC)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:
Last Name:LARKEY-GREEN
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3448 E LAKE LANSING RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1511
Mailing Address - Country:US
Mailing Address - Phone:517-332-3870
Mailing Address - Fax:517-332-9247
Practice Address - Street 1:529 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-4203
Practice Address - Country:US
Practice Address - Phone:517-490-1455
Practice Address - Fax:517-962-0035
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801064381104100000X
MI6401006910101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI19481OtherMEDICARE
MIKL064381OtherMI STATE LICENSE NUMBER
MIKL064381OtherSW LICENSE NUMBER
MIP208972720OtherBCBSM