| NPI | 1073040093 |
|---|---|
| Other Name | LIMITED LICENSE PSYCHOLOGY |
| Entity Type | Organization |
| Authorized Contact | THOMAS NANTAIS COO 313-874-4316 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2017-05-22 |