Provider Demographics
NPI:1164735148
Name:ACTION NET PSYCHOLOGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:ACTION NET PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOE
Authorized Official - Prefix:DR
Authorized Official - First Name:SALMA
Authorized Official - Middle Name:M
Authorized Official - Last Name:AJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-884-2187
Mailing Address - Street 1:27600 FARMINGTON ROAD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3348
Mailing Address - Country:US
Mailing Address - Phone:248-884-2187
Mailing Address - Fax:248-661-2867
Practice Address - Street 1:27600 FARMINGTON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3348
Practice Address - Country:US
Practice Address - Phone:248-884-2187
Practice Address - Fax:248-661-2867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009737252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency