Basic Information
| Provider Information | |||||||||
| NPI: | 1649742792 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAISER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20643 MAPLE LN | ||||||||
| Address2: | |||||||||
| City: | GROSSE POINTE WOODS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482361523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3136719689 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 22708 HARPER AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT CLAIR SHORES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480801823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864452210 | ||||||||
| FaxNumber: | 5864450070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2018 | ||||||||
| LastUpdateDate: | 08/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6401017085 | MI | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | 6401019644 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.