Provider Demographics
NPI:1760092076
Name:KALMBACH, INDIRA K (MA)
Entity Type:Individual
Prefix:
First Name:INDIRA
Middle Name:K
Last Name:KALMBACH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:INDIRA
Other - Middle Name:K
Other - Last Name:KALMBACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8166 SMILEY DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTS
Mailing Address - State:MI
Mailing Address - Zip Code:49088-9765
Mailing Address - Country:US
Mailing Address - Phone:269-339-1240
Mailing Address - Fax:
Practice Address - Street 1:5464 HOLIDAY TER
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2147
Practice Address - Country:US
Practice Address - Phone:269-488-5905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MI101YM0800X
MI6401223083101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health