Provider Demographics
NPI:1144868456
Name:BETH KAFKAKIS MA LLP LLC
Entity type:Organization
Organization Name:BETH KAFKAKIS MA LLP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAFKAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA LLP
Authorized Official - Phone:810-923-7137
Mailing Address - Street 1:2010 HOGBACK RD STE 6D
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-8800
Mailing Address - Country:US
Mailing Address - Phone:810-923-7137
Mailing Address - Fax:
Practice Address - Street 1:2010 HOGBACK RD STE 6D
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-8800
Practice Address - Country:US
Practice Address - Phone:810-923-7137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty