Basic Information
Provider Information
NPI: 1588837736
EntityType: 2
ReplacementNPI:  
OrganizationName: DIANE M KANOUS
LastName:  
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Mailing Information
Address1: 3030 S. 9TH ST.
Address2: SUITE 3E
City: KALAMAZOO
State: MI
PostalCode: 49009
CountryCode: US
TelephoneNumber: 2695447720
FaxNumber: 2695447721
Practice Location
Address1: 3030 S. 9TH ST.
Address2: SUITE 3E
City: KALAMAZOO
State: MI
PostalCode: 49009
CountryCode: US
TelephoneNumber: 2695447720
FaxNumber: 2695447721
Other Information
ProviderEnumerationDate: 04/09/2008
LastUpdateDate: 02/04/2015
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: KANOUS
AuthorizedOfficialFirstName: DIANE
AuthorizedOfficialMiddleName: MARY
AuthorizedOfficialTitleorPosition: OWNER/PSYCHOLOGIST
AuthorizedOfficialTelephone: 2695447720
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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AuthorizedOfficialCredential: MA, LLP
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC1900X6301011265MIY193200000X MULTI-SPECIALTY GROUPBehavioral Health & Social Service ProvidersPsychologistCounseling

No ID Information.


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