| NPI | 1356554059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFERY JOSEPH LUSKO Clinical Program Manager 248-258-0440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2021-04-15 |