=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881558336
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAMAL TAYMOUR PSYCHOLOGICAL COUNSELING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2025
-----------------------------------------------------
Last Update Date | 12/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2575 SPRING ARBOR RD STE 300
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49203-3652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-745-6228
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2575 SPRING ARBOR RD STE 300
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49203-3652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-745-6228
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KAMAL GHAZI
-----------------------------------------------------
Credential | DBH, LCSW-IL, MHA
-----------------------------------------------------
Telephone | 517-745-6228
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------