| NPI | 1295092310 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK STEPHEN JONES Owner 810-966-1972 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301011246) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MI 4301051834) |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2012-06-18 |