Provider Demographics
NPI:1508534074
Name:KALAMAZOO BEHAVIORAL SERVICES, PLC
Entity Type:Organization
Organization Name:KALAMAZOO BEHAVIORAL SERVICES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIMITED LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:269-358-0240
Mailing Address - Street 1:PO BOX 50449
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49005-0449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3311 GREENLEAF BLVD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2516
Practice Address - Country:US
Practice Address - Phone:269-978-0887
Practice Address - Fax:269-978-2757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty