Provider Demographics
NPI:1477219830
Name:PSYCH UP TO WELLNESS, PLLC
Entity Type:Organization
Organization Name:PSYCH UP TO WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-C, ANP-C
Authorized Official - Phone:810-531-8239
Mailing Address - Street 1:3310 RICHARDS DR
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-7238
Mailing Address - Country:US
Mailing Address - Phone:810-531-8239
Mailing Address - Fax:
Practice Address - Street 1:3157 FARNAM STREET
Practice Address - Street 2:SUITE 7104 PMB 7157
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131
Practice Address - Country:US
Practice Address - Phone:402-982-4300
Practice Address - Fax:402-982-4400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health