Provider Demographics
NPI:1154877835
Name:KATHLEEN PRICE IRVIN
Entity type:Organization
Organization Name:KATHLEEN PRICE IRVIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:PRICE
Authorized Official - Last Name:IRVIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-383-4473
Mailing Address - Street 1:2305 FERNWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5256
Mailing Address - Country:US
Mailing Address - Phone:734-383-4473
Mailing Address - Fax:
Practice Address - Street 1:2002 HOGBACK RD
Practice Address - Street 2:#15
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9736
Practice Address - Country:US
Practice Address - Phone:734-383-4473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801058684261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health