Basic Information
| Provider Information | |||||||||
| NPI: | 1407947658 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNITED PSYCHOLOGICAL SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 59100 MOUND RD | ||||||||
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| City: | WASHINGTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480942039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5866771590 | ||||||||
| FaxNumber: | 5866771591 | ||||||||
| Practice Location | |||||||||
| Address1: | 47818 VAN DYKE AVE | ||||||||
| Address2: | |||||||||
| City: | SHELBY TWP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483173373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5863233620 | ||||||||
| FaxNumber: | 5863233568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 11/21/2007 | ||||||||
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| AuthorizedOfficialLastName: | FISHER | ||||||||
| AuthorizedOfficialFirstName: | BARBARA | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5866771590 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 6301002997 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.