Provider Demographics
NPI:1467003087
Name:PARHAM, KENISHA LATOYA (LLP)
Entity type:Individual
Prefix:MS
First Name:KENISHA
Middle Name:LATOYA
Last Name:PARHAM
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29488 WOODWARD AVE # 220
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-0903
Mailing Address - Country:US
Mailing Address - Phone:248-249-1798
Mailing Address - Fax:
Practice Address - Street 1:26105 ORCHARD LAKE RD STE 207
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-4578
Practice Address - Country:US
Practice Address - Phone:248-662-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009115103T00000X
390200000X
MI6361008078103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program