Healthcare Provider Details

I. General information

NPI: 1669303681
Provider Name (Legal Business Name): SELMA KALTAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44777 HAYES RD STE C
STERLING HEIGHTS MI
48313-1421
US

IV. Provider business mailing address

44777 HAYES RD STE C
STERLING HEIGHTS MI
48313-1421
US

V. Phone/Fax

Practice location:
  • Phone: 586-786-8700
  • Fax:
Mailing address:
  • Phone: 586-786-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6362010349
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: