Provider Demographics
NPI:1285017244
Name:KERBY PSYCHOLOGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:KERBY PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KERBY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:269-569-2216
Mailing Address - Street 1:7862 PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4966
Mailing Address - Country:US
Mailing Address - Phone:269-569-2216
Mailing Address - Fax:
Practice Address - Street 1:5955 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-8700
Practice Address - Country:US
Practice Address - Phone:269-569-2216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015083103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty