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General NPI Number Information
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NPI Number | 1992268627
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Entity Type | Organization
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Legal Business Name | KALAMAZOO EMPOWERMENT SERVICES, PLC
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Dates
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Enumeration Date | 04/10/2019
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Last Update Date | 05/02/2022
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Provider Practice Location Address
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Address Line | 834 KING HWY STE 120
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City | KALAMAZOO
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State | MI
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Zip | 49001-2579
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Country | US
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Telephone | 269-598-2837
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Fax | 844-279-3926
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Provider Business Mailing Address
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Address Line | 834 KING HWY STE 120
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City | KALAMAZOO
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State | MI
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Zip | 49001-2579
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Country | US
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Telephone | 269-598-2837
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Fax | 844-279-3926
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | DEANNA OMONIYI
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Credential | LMSW, CAADC, ADS
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Telephone | 269-598-2837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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