| NPI | 1417346966 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERENCE LEE BRADLEY Owner & CEO 231-938-5900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301002718) |
| Enumeration Date | 2015-01-21 |
| Last Update Date | 2015-01-23 |