Healthcare Provider Details

I. General information

NPI: 1457626590
Provider Name (Legal Business Name): BEVIN BEHRENDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HOWARD ST
KALAMAZOO MI
49001-2748
US

IV. Provider business mailing address

401 HOWARD ST
KALAMAZOO MI
49001-2748
US

V. Phone/Fax

Practice location:
  • Phone: 269-344-4458
  • Fax: 269-344-4459
Mailing address:
  • Phone: 269-344-4458
  • Fax: 269-344-4459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberL2073958
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberL2073958
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: