| NPI | 1891385530 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA DAVISSON Biller/Coder 517-740-0184 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TP0016X Psychologist Prescribing (Medical) |
| Enumeration Date | 2021-01-26 |
| Last Update Date | 2021-01-26 |