Provider Demographics
NPI:1427301613
Name:KIDS TALK CHILDREN'S ADVOCACY CENTER
Entity type:Organization
Organization Name:KIDS TALK CHILDREN'S ADVOCACY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KARI
Authorized Official - Middle Name:D
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-785-7700
Mailing Address - Street 1:40 E FERRY ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3802
Mailing Address - Country:US
Mailing Address - Phone:313-833-2970
Mailing Address - Fax:313-638-2470
Practice Address - Street 1:40 E FERRY ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3802
Practice Address - Country:US
Practice Address - Phone:313-833-2970
Practice Address - Fax:313-638-2470
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE GUIDANCE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-25
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI176740Medicaid
MI176740Medicaid