Provider Demographics
NPI:1043083884
Name:MANGIN PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:MANGIN PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LLP
Authorized Official - Phone:734-386-0452
Mailing Address - Street 1:42233 ANN ARBOR RD E
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4364
Mailing Address - Country:US
Mailing Address - Phone:734-386-0452
Mailing Address - Fax:
Practice Address - Street 1:42233 ANN ARBOR RD E
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4364
Practice Address - Country:US
Practice Address - Phone:734-386-0452
Practice Address - Fax:734-419-9023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-02
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health