Provider Demographics
NPI:1407998610
Name:ALBRIGHT, KATHIE J (PHD)
Entity Type:Individual
Prefix:
First Name:KATHIE
Middle Name:J
Last Name:ALBRIGHT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 262
Mailing Address - Street 2:
Mailing Address - City:OMENA
Mailing Address - State:MI
Mailing Address - Zip Code:49674-0262
Mailing Address - Country:US
Mailing Address - Phone:734-330-5515
Mailing Address - Fax:
Practice Address - Street 1:12006 E. TATCH RD.
Practice Address - Street 2:
Practice Address - City:OMENA
Practice Address - State:MI
Practice Address - Zip Code:49674
Practice Address - Country:US
Practice Address - Phone:734-330-5515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005768103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent