Healthcare Provider Details

I. General information

NPI: 1780912568
Provider Name (Legal Business Name): KATHRYN GLENN ROYLE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2009
Last Update Date: 12/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 RAMBLING RD
KALAMAZOO MI
49008-1630
US

IV. Provider business mailing address

8057 W RS AVE
SCHOOLCRAFT MI
49087-8426
US

V. Phone/Fax

Practice location:
  • Phone: 269-345-0909
  • Fax: 269-345-4985
Mailing address:
  • Phone: 269-375-9814
  • Fax: 269-345-4985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401004833
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: