| NPI | 1073987616 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERYL SIAS Credentialing 989-774-2597 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 103TS0200X Psychologist, School |
| Enumeration Date | 2015-11-19 |
| Last Update Date | 2015-11-19 |