Provider Demographics
NPI:1679205124
Name:POWERS, KENDALL (PSY S)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:PSY S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 CANYON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY
Mailing Address - State:MI
Mailing Address - Zip Code:48442-1560
Mailing Address - Country:US
Mailing Address - Phone:248-891-9195
Mailing Address - Fax:
Practice Address - Street 1:818 CANYON CREEK DR
Practice Address - Street 2:
Practice Address - City:HOLLY
Practice Address - State:MI
Practice Address - Zip Code:48442-1560
Practice Address - Country:US
Practice Address - Phone:248-891-9195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MISP0000000916726OtherSCHOOL PSYCHOLOGIST CERTIFICATE