Provider Demographics
NPI:1134851686
Name:KAZYAK, KAREN ANNE
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ANNE
Last Name:KAZYAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 W GRAND RIVER AVE STE 758
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-2392
Mailing Address - Country:US
Mailing Address - Phone:810-227-4432
Mailing Address - Fax:
Practice Address - Street 1:758 W GRAND RIVER AVE STE 758
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2392
Practice Address - Country:US
Practice Address - Phone:810-227-4432
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 Licenses
StateLicense IDTaxonomies
MI6361003793103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist