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General NPI Number Information
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NPI Number | 1770463549
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Entity Type | Individual
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Provider Name | KATHRYN ANN FAZZALARE LPC
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Gender | Female
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Dates
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Enumeration Date | 09/03/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 43565 ELIZABETH ST
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-1001
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Country | US
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Telephone | 586-307-9464
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Fax | 586-307-9305
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Provider Business Mailing Address
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Address Line | 43565 ELIZABETH ST
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-1001
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Country | US
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Telephone | 586-307-9464
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Fax | 586-307-9305
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | MI
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