Provider Demographics
NPI:1265983472
Name:KATHY CHEN PSYD PLLC
Entity type:Organization
Organization Name:KATHY CHEN PSYD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-479-8193
Mailing Address - Street 1:1558 DONNA AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-2051
Mailing Address - Country:US
Mailing Address - Phone:312-479-8193
Mailing Address - Fax:
Practice Address - Street 1:17376 W 12 MILE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2118
Practice Address - Country:US
Practice Address - Phone:312-479-8193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-23
Last Update Date:2016-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health