Provider Demographics
NPI:1033318340
Name:MIDWEST MICHIGAN PSYCHOLOGICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:MIDWEST MICHIGAN PSYCHOLOGICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DERROR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:231-878-3059
Mailing Address - Street 1:811 SUNNYSIDE DR
Mailing Address - Street 2:SUITE I
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-7002
Mailing Address - Country:US
Mailing Address - Phone:231-878-3059
Mailing Address - Fax:866-217-1182
Practice Address - Street 1:811 SUNNYSIDE DR
Practice Address - Street 2:SUITE I
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-7002
Practice Address - Country:US
Practice Address - Phone:231-878-3059
Practice Address - Fax:866-217-1182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401004326101YP2500X
MI6301013463103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty