| NPI | 1003397035 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY BETH HOUPT Credentialing 517-676-9788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: MI 601012798) |
| Enumeration Date | 2018-08-28 |
| Last Update Date | 2018-08-28 |