Provider Demographics
NPI:1174051619
Name:KANAAN THERAPY AND BEHAVIORAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:KANAAN THERAPY AND BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ADLI
Authorized Official - Last Name:KANAAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:269-815-8168
Mailing Address - Street 1:816 EAST MICHIGAN AVENUE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-9510
Mailing Address - Country:US
Mailing Address - Phone:269-815-8168
Mailing Address - Fax:
Practice Address - Street 1:816 EAST MICHIGAN AVENUE
Practice Address - Street 2:SUITE 103
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-9510
Practice Address - Country:US
Practice Address - Phone:269-815-8168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-29
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010926141041C0700X
MI6401012892101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty