Provider Demographics
NPI:1205080934
Name:NELSON, KATHLEEN KREMSER (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:KREMSER
Last Name:NELSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 N MILFORD RD STE 205
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-5109
Mailing Address - Country:US
Mailing Address - Phone:248-889-5767
Mailing Address - Fax:248-714-1480
Practice Address - Street 1:1042 N MILFORD RD STE 205
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-5109
Practice Address - Country:US
Practice Address - Phone:248-889-5767
Practice Address - Fax:248-714-1480
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008117103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F332330OtherBCBS
MI1205042959OtherGROUP NPI