Provider Demographics
NPI:1992268627
Name:KALAMAZOO EMPOWERMENT SERVICES, PLC
Entity type:Organization
Organization Name:KALAMAZOO EMPOWERMENT SERVICES, PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:OMONIYI
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, CAADC, ADS
Authorized Official - Phone:269-598-2837
Mailing Address - Street 1:834 KING HWY STE 120
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-2579
Mailing Address - Country:US
Mailing Address - Phone:269-598-2837
Mailing Address - Fax:844-279-3926
Practice Address - Street 1:834 KING HWY STE 120
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-2579
Practice Address - Country:US
Practice Address - Phone:269-598-2837
Practice Address - Fax:844-279-3926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health