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General NPI Number Information
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NPI Number | 1306145420
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Entity Type | Organization
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Legal Business Name | KALAMAZOO PSYCHOLOGY
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Dates
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Enumeration Date | 03/16/2011
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Last Update Date | 03/16/2011
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Provider Practice Location Address
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Address Line | 122 W SOUTH ST
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City | KALAMAZOO
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State | MI
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Zip | 49007-4711
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Country | US
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Telephone | 269-349-4219
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Fax | 269-349-5107
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Provider Business Mailing Address
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Address Line | 122 W SOUTH ST
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City | KALAMAZOO
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State | MI
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Zip | 49007-4711
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Country | US
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Telephone | 269-349-4219
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Fax | 269-349-5107
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Authorized Official
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Title or Position | OWNER
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Name | MS. KIMBERLY LEM
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Credential | LLP
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Telephone | 269-349-4219
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | L1929389
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License Number State | MI
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