Provider Demographics
NPI:1982427878
Name:KPSYCH PLLC
Entity type:Organization
Organization Name:KPSYCH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-605-8500
Mailing Address - Street 1:98 WINCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-1957
Mailing Address - Country:US
Mailing Address - Phone:734-605-8500
Mailing Address - Fax:734-242-8563
Practice Address - Street 1:98 WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-1957
Practice Address - Country:US
Practice Address - Phone:734-605-8500
Practice Address - Fax:734-242-8563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-07
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty