Healthcare Provider Details

I. General information

NPI: 1649213794
Provider Name (Legal Business Name): REBECCA LYNN KALASKY MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 W LONG LAKE RD STE 225
TROY MI
48098-4531
US

IV. Provider business mailing address

880 W LONG LAKE RD STE 225
TROY MI
48098-4531
US

V. Phone/Fax

Practice location:
  • Phone: 248-413-7744
  • Fax:
Mailing address:
  • Phone: 248-413-7744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401008612
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: