Provider Demographics
NPI:1073348884
Name:KESTLER, MALLORY M
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:M
Last Name:KESTLER
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 1:23128 GLENMOOR HTS
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3534
Mailing Address - Country:US
Mailing Address - Phone:248-234-1990
Mailing Address - Fax:
Practice Address - Street 1:3920 W. BIG BEAVER RD.
Practice Address - Street 2:SUITE 510
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084
Practice Address - Country:US
Practice Address - Phone:586-404-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician