| NPI | 1730308115 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY L BRACISZEWSKI Director 734-320-2497 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MI 6301006431) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301006431) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6301006431) | |
| 103TC0700X Psychologist, Clinical (Licence: MI 6301006431) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MI 6301006431) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: MI 6301006431) | |
| 103TH0100X Psychologist, Health Service (Licence: MI 6301006431) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2014-04-25 |