Provider Demographics
NPI:1558084467
Name:PRAHLER EISEL, KATHLEEN ILDA (LLMSW, CRC)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ILDA
Last Name:PRAHLER EISEL
Suffix:
Gender:F
Credentials:LLMSW, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 MASON ST STE B220
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2262
Mailing Address - Country:US
Mailing Address - Phone:313-561-9064
Mailing Address - Fax:
Practice Address - Street 1:835 MASON ST STE B220
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2262
Practice Address - Country:US
Practice Address - Phone:313-561-9064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511128231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical