Provider Demographics
NPI:1043510134
Name:STUART L. DONESON PHD. & ASSOCIATES,P.C.
Entity Type:Organization
Organization Name:STUART L. DONESON PHD. & ASSOCIATES,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:L
Authorized Official - Last Name:DONESON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:517-203-3300
Mailing Address - Street 1:4572 S HAGADORN RD
Mailing Address - Street 2:SUITE 2-H
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5385
Mailing Address - Country:US
Mailing Address - Phone:517-203-3300
Mailing Address - Fax:
Practice Address - Street 1:4572 S HAGADORN RD
Practice Address - Street 2:SUITE 2-H
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5385
Practice Address - Country:US
Practice Address - Phone:517-203-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-24
Last Update Date:2010-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI005005103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M89660Medicare PIN