Basic Information
| Provider Information | |||||||||
| NPI: | 1023216702 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAGINAW PSYCHOLOGICAL SERVICES INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 HEMMETER RD | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486033944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897992100 | ||||||||
| FaxNumber: | 9897992637 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 HEMMETER RD | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486033944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897992100 | ||||||||
| FaxNumber: | 9897992637 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ERWIN | ||||||||
| AuthorizedOfficialFirstName: | FRANCES | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9897992100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMSW, ACSW, LMFT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 0917317 | 01 | MI | BCBS OPC FOR LMSW, LPC | OTHER |