Healthcare Provider Details

I. General information

NPI: 1508534074
Provider Name (Legal Business Name): KALAMAZOO BEHAVIORAL SERVICES, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 GREENLEAF BLVD
KALAMAZOO MI
49008-2516
US

IV. Provider business mailing address

PO BOX 50449
KALAMAZOO MI
49005-0449
US

V. Phone/Fax

Practice location:
  • Phone: 269-978-0887
  • Fax: 269-978-2757
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS CUNNINGHAM
Title or Position: LIMITED LICENSED PSYCHOLOGIST
Credential: LLP
Phone: 269-358-0240