| NPI | 1023736212 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY LEID Director Of Revenue Cycle 313-262-0951 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Enumeration Date | 2022-08-15 |
| Last Update Date | 2022-08-15 |