Healthcare Provider Details

I. General information

NPI: 1356983886
Provider Name (Legal Business Name): KATE ELIZABETH DYKHUIS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W MAIN ST STE 207
NORTHVILLE MI
48167-1584
US

IV. Provider business mailing address

24299 BUCHANAN CT APT 1974
FARMINGTON HILLS MI
48335-2120
US

V. Phone/Fax

Practice location:
  • Phone: 248-567-6276
  • Fax:
Mailing address:
  • Phone: 616-648-2936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301017521
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: