Provider Demographics
NPI:1306376546
Name:AGIUS PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:AGIUS PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AGIUS
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:810-288-6652
Mailing Address - Street 1:237 ARMSTRONG ST
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-1728
Mailing Address - Country:US
Mailing Address - Phone:810-210-4894
Mailing Address - Fax:
Practice Address - Street 1:1440 TORREY RD STE E
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430
Practice Address - Country:US
Practice Address - Phone:810-288-6652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-19
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty