Provider Demographics
NPI:1073248993
Name:KATELIN ZYLKA LMSW, PLLC
Entity Type:Organization
Organization Name:KATELIN ZYLKA LMSW, PLLC
Other - Org Name:DESERT BLOOM THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZYLKA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-892-9497
Mailing Address - Street 1:16918 COMSTOCK ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1608
Mailing Address - Country:US
Mailing Address - Phone:248-892-9497
Mailing Address - Fax:
Practice Address - Street 1:39325 PLYMOUTH RD STE 202
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-4531
Practice Address - Country:US
Practice Address - Phone:734-404-5835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-24
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty