Provider Demographics
NPI:1225572696
Name:ALLIANCE PSYCHOLOGICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:ALLIANCE PSYCHOLOGICAL ASSOCIATES, PLLC
Other - Org Name:DR. NICOLE T. BUCHANAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:517-575-7449
Mailing Address - Street 1:PO BOX 1353
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48826-1353
Mailing Address - Country:US
Mailing Address - Phone:517-575-7449
Mailing Address - Fax:866-333-5591
Practice Address - Street 1:200 WOODLAND PASS STE E
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-2000
Practice Address - Country:US
Practice Address - Phone:517-575-7449
Practice Address - Fax:866-333-5591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012177103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty