Provider Demographics
NPI:1063538049
Name:SPRINGER, KYRRA A
Entity type:Individual
Prefix:
First Name:KYRRA
Middle Name:A
Last Name:SPRINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3046 SIGNATURE BLVD
Mailing Address - Street 2:APT A
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6916
Mailing Address - Country:US
Mailing Address - Phone:248-668-0922
Mailing Address - Fax:248-668-0924
Practice Address - Street 1:2045 E WEST MAPLE RD
Practice Address - Street 2:D405
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-3801
Practice Address - Country:US
Practice Address - Phone:248-668-0922
Practice Address - Fax:248-668-0924
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802085842101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health