Provider Demographics
NPI:1073684114
Name:GENESIS PSYCHOLOGICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:GENESIS PSYCHOLOGICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-446-0200
Mailing Address - Street 1:415 S LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-1458
Mailing Address - Country:US
Mailing Address - Phone:248-446-0200
Mailing Address - Fax:248-446-0355
Practice Address - Street 1:415 S LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-1458
Practice Address - Country:US
Practice Address - Phone:248-446-0200
Practice Address - Fax:248-446-0355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-12
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003335103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680F332290OtherBLUE CROSS BLUE SHIELD
MI0P39380Medicare PIN