Provider Demographics
NPI:1295024487
Name:KBK COUNSELING SERVICES, P.C.
Entity Type:Organization
Organization Name:KBK COUNSELING SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:KETOLA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:586-216-4553
Mailing Address - Street 1:5316 BREEZE HILL PL
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-2725
Mailing Address - Country:US
Mailing Address - Phone:248-952-5853
Mailing Address - Fax:
Practice Address - Street 1:39520 WOODWARD AVE
Practice Address - Street 2:SUITE 233
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-5054
Practice Address - Country:US
Practice Address - Phone:586-216-4553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010662331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0899799OtherBLUE CROSS BLUE SHIELD
MION74420Medicare PIN