Provider Demographics
NPI:1619274636
Name:DANIEL J. KACHMAN, ED. D., P.C.
Entity Type:Organization
Organization Name:DANIEL J. KACHMAN, ED. D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KACHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ED D
Authorized Official - Phone:810-664-4363
Mailing Address - Street 1:700 S MAIN ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-3077
Mailing Address - Country:US
Mailing Address - Phone:810-664-4363
Mailing Address - Fax:810-664-4364
Practice Address - Street 1:700 S MAIN ST
Practice Address - Street 2:SUITE 208
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3077
Practice Address - Country:US
Practice Address - Phone:810-664-4363
Practice Address - Fax:810-664-4364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-28
Last Update Date:2016-06-29
Deactivation Date:2014-04-28
Deactivation Code:
Reactivation Date:2014-07-21
Provider Licenses
StateLicense IDTaxonomies
MI6301002139251S00000X
MI4101005376251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D44517Medicaid