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General NPI Number Information
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NPI Number | 1205042959
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Entity Type | Organization
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Legal Business Name | KATHLEEN NELSON PH.D., PLC
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 1042 N MILFORD RD STE 205
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City | MILFORD
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State | MI
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Zip | 48381-5109
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Country | US
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Telephone | 248-889-5767
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Fax | 248-714-1480
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Provider Business Mailing Address
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Address Line | 1042 N MILFORD RD STE 205
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City | MILFORD
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State | MI
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Zip | 48381-5109
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Country | US
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Telephone | 248-889-5767
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Fax | 248-714-1480
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Authorized Official
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Title or Position | OWNER
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Name | DR. KATHLEEN KREMSER NELSON
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Credential | PH.D.
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Telephone | 248-889-5767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301008117
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License Number State | MI
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