| NPI | 1205205747 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY ADAM MOEGGENBERG Owner 989-317-3188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301014926) |
| Enumeration Date | 2015-09-15 |
| Last Update Date | 2019-01-04 |