Basic Information
| Provider Information | |||||||||
| NPI: | 1851747554 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DANA HOWLEY PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23647 WOODWARD AVE STE 2 | ||||||||
| Address2: | |||||||||
| City: | PLEASANT RIDGE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480691136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487655822 | ||||||||
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| Practice Location | |||||||||
| Address1: | 23647 WOODWARD AVE STE 2 | ||||||||
| Address2: | |||||||||
| City: | PLEASANT RIDGE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480691136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487655822 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2016 | ||||||||
| LastUpdateDate: | 05/11/2016 | ||||||||
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| AuthorizedOfficialLastName: | HOWLEY | ||||||||
| AuthorizedOfficialFirstName: | DANA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER / AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 2487655822 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PSY.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 6301015718 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.