| Diane M Kanous | |
|
3030 S. 9th St. Suite 3e Kalamazoo MI 49009 | |
| (269) 544-7720 | |
| (269) 544-7721 |
| Full Name | Diane M Kanous |
|---|---|
| Speciality | Psychologist |
| Location | 3030 S. 9th St., Kalamazoo, Michigan |
| Authorized Official Name and Position | Diane Mary Kanous (OWNER/PSYCHOLOGIST) |
| Authorized Official Contact | 2695447720 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Diane M Kanous 3030 S. 9th St. Suite 3e Kalamazoo MI 49009 Ph: (269) 544-7720 | Diane M Kanous 3030 S. 9th St. Suite 3e Kalamazoo MI 49009 Ph: (269) 544-7720 |
| NPI Number | 1588837736 |
|---|---|
| Provider Enumeration Date | 04/09/2008 |
| Last Update Date | 02/04/2015 |
| Medicare PECOS PAC ID | 0143389031 |
|---|---|
| Medicare Enrollment ID | O20081106000758 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588837736 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | 6301011265 (Michigan) | Primary |
| Provider Name | Scott A Kelly |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1184892051 PECOS PAC ID: 4587563820 Enrollment ID: I20040106000162 |
| Provider Name | George T Starrett |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548244635 PECOS PAC ID: 5496640310 Enrollment ID: I20040219000348 |
| Provider Name | Stacey S Fox |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952674699 PECOS PAC ID: 9537392006 Enrollment ID: I20140507002127 |
| Provider Name | Leah R Keller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568849099 PECOS PAC ID: 3870814445 Enrollment ID: I20150608001946 |
| Provider Name | Elaine Lee Bussema |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013467083 PECOS PAC ID: 6103103734 Enrollment ID: I20170508001541 |
| Provider Name | Kelle L Brooks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023498375 PECOS PAC ID: 9931451952 Enrollment ID: I20181002002980 |
| Provider Name | Kellie Hakken |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740660968 PECOS PAC ID: 8729328828 Enrollment ID: I20190328000747 |
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