Basic Information
| Provider Information | |||||||||
| NPI: | 1760400774 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ST. JOHN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | GREGORY | ||||||||
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| Credential: | PHD, LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23231 WOODWARD AVE | ||||||||
| Address2: | |||||||||
| City: | FERNDALE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482201361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343250491 | ||||||||
| FaxNumber: | 7342075326 | ||||||||
| Practice Location | |||||||||
| Address1: | 23231 WOODWARD AVE | ||||||||
| Address2: | |||||||||
| City: | FERNDALE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482201361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343250491 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 03/14/2018 | ||||||||
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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 | 103T00000X | 6301012887 | MI | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.