Provider Demographics
NPI:1477174589
Name:LTD PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:LTD PSYCHOLOGICAL SERVICES
Other - Org Name:AUTHENTIC SELF PSYCHOLOGICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KALAJ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:313-506-0658
Mailing Address - Street 1:15 E KIRBY ST
Mailing Address - Street 2:SUITE 107B
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202
Mailing Address - Country:US
Mailing Address - Phone:313-506-0658
Mailing Address - Fax:
Practice Address - Street 1:15 E KIRBY ST
Practice Address - Street 2:SUITE 107B
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-4043
Practice Address - Country:US
Practice Address - Phone:313-506-0658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-29
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health