Provider Demographics
NPI:1548750524
Name:KATELYN CABLE MA LLP
Entity Type:Organization
Organization Name:KATELYN CABLE MA LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CABLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LLP
Authorized Official - Phone:616-460-3203
Mailing Address - Street 1:5001 PLAINFIELD AVE SE
Mailing Address - Street 2:STE B
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9349
Mailing Address - Country:US
Mailing Address - Phone:616-278-0551
Mailing Address - Fax:616-278-0145
Practice Address - Street 1:5001 PLAINFIELD AVE SE
Practice Address - Street 2:SUITE B
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9349
Practice Address - Country:US
Practice Address - Phone:616-278-0551
Practice Address - Fax:616-278-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016606101YM0800X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty