| NPI | 1104254051 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATHY S GALLEGOS Manager Billing 517-483-2461 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301014845) |
| Enumeration Date | 2013-10-30 |
| Last Update Date | 2013-11-19 |