| NPI | 1659513208 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE G DOUGLASS Manager 231-342-5877 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TF0000X Psychologist, Family (Licence: MI 6301003193) |
| Enumeration Date | 2009-03-28 |
| Last Update Date | 2021-02-27 |