| NPI | 1669717823 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIS RUSSELL Chief Executive Officer 810-257-3736 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 103TF0000X Psychologist, Family |
| Enumeration Date | 2012-11-29 |
| Last Update Date | 2019-02-15 |