Basic Information
| Provider Information | |||||||||
| NPI: | 1396833208 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SERMIC PSYCHOLOGICAL AND COUNSELING ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 116 W SUPERIOR ST | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | ALMA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488011650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9895760554 | ||||||||
| FaxNumber: | 9894636390 | ||||||||
| Practice Location | |||||||||
| Address1: | 116 W SUPERIOR ST | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | ALMA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488011650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9895760554 | ||||||||
| FaxNumber: | 9894636390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 03/18/2013 | ||||||||
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| AuthorizedOfficialLastName: | BRADY | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | SCOTT | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9895760554 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 6301012763 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.