Provider Demographics
NPI:1427510189
Name:KALEIDOSCOPE COUNSELING SERVICES PLLC
Entity type:Organization
Organization Name:KALEIDOSCOPE COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:INGLESON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:231-590-3167
Mailing Address - Street 1:424 PETOSKEY STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2618
Mailing Address - Country:US
Mailing Address - Phone:231-590-3167
Mailing Address - Fax:231-715-3787
Practice Address - Street 1:424 PETOSKEY STREET
Practice Address - Street 2:SUITE C
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2618
Practice Address - Country:US
Practice Address - Phone:231-590-3167
Practice Address - Fax:231-715-3787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty