Provider Demographics
NPI:1326441809
Name:EXCELSIOR PSYCHOLOGICAL SERVICES, PLC
Entity Type:Organization
Organization Name:EXCELSIOR PSYCHOLOGICAL SERVICES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:GALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-656-5003
Mailing Address - Street 1:11111 HALL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5799
Mailing Address - Country:US
Mailing Address - Phone:248-656-5003
Mailing Address - Fax:248-656-5004
Practice Address - Street 1:11111 HALL RD STE 105
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5799
Practice Address - Country:US
Practice Address - Phone:248-656-5003
Practice Address - Fax:248-656-5004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011878103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty