Basic Information
| Provider Information | |||||||||
| NPI: | 1740494723 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENGLISH | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LLP, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1547 S. WAYNE RD. | ||||||||
| Address2: | |||||||||
| City: | WESTLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344050175 | ||||||||
| FaxNumber: | 7344050185 | ||||||||
| Practice Location | |||||||||
| Address1: | 1547. S. WAYNE RD. | ||||||||
| Address2: | |||||||||
| City: | WESTLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344050175 | ||||||||
| FaxNumber: | 7344050185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 08/14/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6401005037 | MI | N | Behavioral Health & Social Service Providers | Counselor | 103TC1900X | 6301010389 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
ID Information
| ID | Type | State | Issuer | Description | 1883825 | 05 | MI | MEDICAID |