Provider Demographics
NPI:1295814200
Name:PATRICIA M. MOYLAN PHD PLLC
Entity Type:Organization
Organization Name:PATRICIA M. MOYLAN PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SINGLE MEMBER PLLC
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOYLAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-553-2558
Mailing Address - Street 1:28595 ORCHARD LAKE RD
Mailing Address - Street 2:STE. 125
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2977
Mailing Address - Country:US
Mailing Address - Phone:248-553-2558
Mailing Address - Fax:
Practice Address - Street 1:28595 ORCHARD LAKE RD
Practice Address - Street 2:STE. 125
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2977
Practice Address - Country:US
Practice Address - Phone:248-553-2558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006253103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty