| NPI | 1225639990 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MINDY ERIN FORMAN Clinical Psychologisy 248-703-4880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-11-07 |
| Last Update Date | 2020-12-07 |