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General NPI Number Information
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NPI Number | 1922498393
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Entity Type | Organization
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Legal Business Name | KALAMAZOO PROBATION ENHANCEMENT PROGRAM
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Dates
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Enumeration Date | 01/23/2015
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Last Update Date | 01/23/2015
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Provider Practice Location Address
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Address Line | 519 S PARK ST
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City | KALAMAZOO
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State | MI
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Zip | 49007-5117
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Country | US
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Telephone | 269-383-0450
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Fax | 269-383-2066
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Provider Business Mailing Address
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Address Line | 519 S PARK ST
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City | KALAMAZOO
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State | MI
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Zip | 49007-5117
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Country | US
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Telephone | 269-383-0450
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Fax | 269-383-2066
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. WILLIAM DEBOER
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Credential |
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Telephone | 269-903-0510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 390145
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License Number State | MI
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