Provider Demographics
NPI:1518326511
Name:CABLE, KATELYN (MA, LLP)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:CABLE
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 PLAINFIELD AVE NE STE B
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1050
Mailing Address - Country:US
Mailing Address - Phone:616-278-0551
Mailing Address - Fax:616-278-0145
Practice Address - Street 1:5001 PLAINFIELD AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1050
Practice Address - Country:US
Practice Address - Phone:616-278-0551
Practice Address - Fax:616-278-0145
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016606101YM0800X
MI6361001948101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health