| NPI | 1205223468 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHRYN J PENFOLD Sole Member 231-590-6242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301008173) |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2015-04-24 |