Provider Demographics
NPI:1083879852
Name:KALAMAZOO PSYCHOLOGY, LLC
Entity Type:Organization
Organization Name:KALAMAZOO PSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEM
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LLP
Authorized Official - Phone:269-349-4219
Mailing Address - Street 1:122 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-4711
Mailing Address - Country:US
Mailing Address - Phone:269-349-4219
Mailing Address - Fax:269-249-5107
Practice Address - Street 1:122 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-4711
Practice Address - Country:US
Practice Address - Phone:269-349-4219
Practice Address - Fax:269-249-5107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty