Provider Demographics
NPI:1396080669
Name:KALAMAZOO COUNSELING CONNECTION
Entity type:Organization
Organization Name:KALAMAZOO COUNSELING CONNECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:ALBER
Authorized Official - Last Name:LECLEAR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:269-370-2899
Mailing Address - Street 1:1710 GOLFVIEW AVE
Mailing Address - Street 2:#1
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-5296
Mailing Address - Country:US
Mailing Address - Phone:269-370-2899
Mailing Address - Fax:510-201-7713
Practice Address - Street 1:225 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5163
Practice Address - Country:US
Practice Address - Phone:269-370-2899
Practice Address - Fax:510-201-7713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009362251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health