| NPI | 1972041648 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY BETH HOUPT Credentialing 517-676-9788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301016014) |
| Enumeration Date | 2017-02-02 |
| Last Update Date | 2021-05-27 |