Basic Information
| Provider Information | |||||||||
| NPI: | 1891059119 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAKHAI | ||||||||
| FirstName: | KIMBERLY | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8892 LILLY DR | ||||||||
| Address2: | |||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481979658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7164305902 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4250 PLYMOUTH ROAD | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481092700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347646443 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2012 | ||||||||
| LastUpdateDate: | 11/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801100438 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.