Provider Demographics
NPI:1073242632
Name:CENTER FOR INTEGRATED HEALTH AND WELL-BEING, P.C.
Entity Type:Organization
Organization Name:CENTER FOR INTEGRATED HEALTH AND WELL-BEING, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KOTLARZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-398-7574
Mailing Address - Street 1:221 S MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2653
Mailing Address - Country:US
Mailing Address - Phone:248-398-7574
Mailing Address - Fax:248-398-6265
Practice Address - Street 1:221 S MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2653
Practice Address - Country:US
Practice Address - Phone:248-398-7574
Practice Address - Fax:248-398-6265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty