Healthcare Provider Details

I. General information

NPI: 1023947314
Provider Name (Legal Business Name): KLARA HATAM KOSTO MS, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38550 GARFIELD RD STE B
CLINTON TOWNSHIP MI
48038-3406
US

IV. Provider business mailing address

38550 GARFIELD RD STE B
CLINTON TOWNSHIP MI
48038-3406
US

V. Phone/Fax

Practice location:
  • Phone: 586-741-6208
  • Fax: 586-741-6210
Mailing address:
  • Phone: 616-805-9821
  • Fax: 586-741-6210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401003358
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: