Provider Demographics
NPI:1477349223
Name:CALLY KANTARIAN TLLP INC
Entity type:Organization
Organization Name:CALLY KANTARIAN TLLP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CALLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KANTARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:248-701-7297
Mailing Address - Street 1:20265 S GREENWAY ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-5024
Mailing Address - Country:US
Mailing Address - Phone:248-701-7297
Mailing Address - Fax:
Practice Address - Street 1:1035 S ADAMS RD STE E
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-7422
Practice Address - Country:US
Practice Address - Phone:248-701-7297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty