Basic Information
Provider Information | |||||||||
NPI: | 1700971157 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SAELENS | ||||||||
FirstName: | DEBORAH | ||||||||
MiddleName: | LYNN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MA, LLP, LPC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | TEEMS | ||||||||
OtherFirstName: | DEBORAH | ||||||||
OtherMiddleName: | LYNN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 28000 DEQUINDRE RD | ||||||||
Address2: |   | ||||||||
City: | WARREN | ||||||||
State: | MI | ||||||||
PostalCode: | 48092 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5867530405 | ||||||||
FaxNumber: | 5867530404 | ||||||||
Practice Location | |||||||||
Address1: | 23045 MAIN ST | ||||||||
Address2: |   | ||||||||
City: | ARMADA | ||||||||
State: | MI | ||||||||
PostalCode: | 48005 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5867848860 | ||||||||
FaxNumber: | 5867848870 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/03/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6401006726 | MI | X |   | Behavioral Health & Social Service Providers | Counselor |   | 103T00000X | 6301010725 | MI | X |   | Behavioral Health & Social Service Providers | Psychologist |   |
No ID Information.