Provider Demographics
NPI:1588837736
Name:DIANE M KANOUS
Entity Type:Organization
Organization Name:DIANE M KANOUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:KANOUS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LLP
Authorized Official - Phone:269-544-7720
Mailing Address - Street 1:3030 S. 9TH ST.
Mailing Address - Street 2:SUITE 3E
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009
Mailing Address - Country:US
Mailing Address - Phone:269-544-7720
Mailing Address - Fax:269-544-7721
Practice Address - Street 1:3030 S. 9TH ST.
Practice Address - Street 2:SUITE 3E
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009
Practice Address - Country:US
Practice Address - Phone:269-544-7720
Practice Address - Fax:269-544-7721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011265103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty