Healthcare Provider Details

I. General information

NPI: 1477174589
Provider Name (Legal Business Name): LTD PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E KIRBY ST SUITE 107B
DETROIT MI
48202-4043
US

IV. Provider business mailing address

15 E KIRBY ST SUITE 107B
DETROIT MI
48202
US

V. Phone/Fax

Practice location:
  • Phone: 313-506-0658
  • Fax:
Mailing address:
  • Phone: 313-506-0658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISTINA KALAJ
Title or Position: OWNER/PSYCHOLOGIST
Credential: PSYD
Phone: 313-506-0658