1912489964 NPI number — KUZNAR PSYCHOLOGY FOR WELLNESS AND WELL-BEING, LLC

Table of content: (NPI 1912489964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912489964 NPI number — KUZNAR PSYCHOLOGY FOR WELLNESS AND WELL-BEING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KUZNAR PSYCHOLOGY FOR WELLNESS AND WELL-BEING, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912489964
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37095 DICKINSON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48335-4818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-259-2382
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18600 NORTHVILLE RD STE 400C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHVILLE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48168-3544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-243-4386
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/05/2018

Additional Information

Authorized Official

Authorized Official Last Name:
KUZNAR
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
OWNER/PRACTITIONER
Authorized Official Telephone Number:
248-259-2382

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  6401015602 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YS0200X , with the licence number: PF0000000882476 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1649720111 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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