Healthcare Provider Details

I. General information

NPI: 1427919356
Provider Name (Legal Business Name): KATHLEEN CORPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 EMMET ST
PETOSKEY MI
49770-2910
US

IV. Provider business mailing address

4827 S STRAITS HWY APT 1
INDIAN RIVER MI
49749-9000
US

V. Phone/Fax

Practice location:
  • Phone: 231-347-5511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: