Provider Demographics
NPI:1407937865
Name:KINDT, CAROL URQUHART (MSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:URQUHART
Last Name:KINDT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 HANNAH AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3399
Mailing Address - Country:US
Mailing Address - Phone:231-935-1766
Mailing Address - Fax:231-935-0061
Practice Address - Street 1:697 HANNAH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3399
Practice Address - Country:US
Practice Address - Phone:231-935-1766
Practice Address - Fax:231-935-0061
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010189491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OM31870Medicare ID - Type Unspecified