Healthcare Provider Details

I. General information

NPI: 1497100507
Provider Name (Legal Business Name): K RILEY AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 COOLIDGE HWY SUITE 110
TROY MI
48084-7069
US

IV. Provider business mailing address

1380 COOLIDGE HWY SUITE 110
TROY MI
48084-7069
US

V. Phone/Fax

Practice location:
  • Phone: 248-321-9200
  • Fax:
Mailing address:
  • Phone: 248-321-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN ANN RILEY
Title or Position: PRESIDENT
Credential:
Phone: 248-321-9200