=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265266498
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KP & ASSOCIATES, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2024
-----------------------------------------------------
Last Update Date | 08/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3940 PENINSULAR DR SE STE 230
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49546-6187
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-856-0037
-----------------------------------------------------
Fax | 616-699-4750
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3940 PENINSULAR DR SE STE 230
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49546-6187
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-856-0037
-----------------------------------------------------
Fax | 616-699-4750
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICIAN
-----------------------------------------------------
Name | MR. KERBY KILLINGHAM
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 616-856-0037
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------