| NPI | 1265860316 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY CATHERINE JACKSON-GROSSBLAT Licensed Psychologist 269-208-0002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling |
| Enumeration Date | 2013-10-29 |
| Last Update Date | 2013-11-26 |