Provider Demographics
NPI:1457381451
Name:AUGUST, KATHY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:
Last Name:AUGUST
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S WEST ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2521
Mailing Address - Country:US
Mailing Address - Phone:248-546-6432
Mailing Address - Fax:248-546-8070
Practice Address - Street 1:415 S WEST ST
Practice Address - Street 2:SUITE 150
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2521
Practice Address - Country:US
Practice Address - Phone:248-546-6432
Practice Address - Fax:248-546-8070
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007984103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F33099Medicare UPIN