Provider Demographics
NPI:1073112843
Name:KANETI PSYCHOLOGY SERVICES, LLC
Entity Type:Organization
Organization Name:KANETI PSYCHOLOGY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHARINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KANETI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:616-246-1472
Mailing Address - Street 1:4070 LAKE DR SE STE 101
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8294
Mailing Address - Country:US
Mailing Address - Phone:616-246-1472
Mailing Address - Fax:
Practice Address - Street 1:4070 LAKE DR SE STE 101
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8294
Practice Address - Country:US
Practice Address - Phone:616-449-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health