Healthcare Provider Details

I. General information

NPI: 1962171835
Provider Name (Legal Business Name): KATHRYN ELIZABETH WHITLOCK ATR-BC, LPC, CCTP-II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14411 KINGSTON ST
OAK PARK MI
48237-1141
US

IV. Provider business mailing address

14411 KINGSTON ST
OAK PARK MI
48237-1141
US

V. Phone/Fax

Practice location:
  • Phone: 248-736-3347
  • Fax:
Mailing address:
  • Phone: 248-736-3347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451019659
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: