| NPI | 1114001468 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY RATOWSKI Director Office Of Provider Affairs 248-703-2003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 830190) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 101Y00000X Counselor | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2024-03-06 |