Healthcare Provider Details

I. General information

NPI: 1760972475
Provider Name (Legal Business Name): CALLI FAITH KREUTZBERGER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3970 HERITAGE AVE
OKEMOS MI
48864-3344
US

IV. Provider business mailing address

3970 HERITAGE AVE
OKEMOS MI
48864-3344
US

V. Phone/Fax

Practice location:
  • Phone: 517-507-5892
  • Fax:
Mailing address:
  • Phone: 517-507-5892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401018560
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: