Provider Demographics
NPI:1093984817
Name:PARTNERS IN CHANGE: PSYCHOLOGICAL & COMMUNITY SERVICES, PLC
Entity Type:Organization
Organization Name:PARTNERS IN CHANGE: PSYCHOLOGICAL & COMMUNITY SERVICES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:DATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-832-2165
Mailing Address - Street 1:PO BOX 2875
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48641-2875
Mailing Address - Country:US
Mailing Address - Phone:989-832-2165
Mailing Address - Fax:989-839-4376
Practice Address - Street 1:720 W WACKERLY ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2769
Practice Address - Country:US
Practice Address - Phone:989-832-2165
Practice Address - Fax:989-839-4376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009535103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION15630Medicare PIN