Provider Demographics
NPI:1336495746
Name:MAJCHRZAK, JASON DAVID (MS, TLLP)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DAVID
Last Name:MAJCHRZAK
Suffix:
Gender:M
Credentials:MS, TLLP
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Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-1863
Mailing Address - Fax:947-522-0307
Practice Address - Street 1:18501 ROTUNDA DR STE 100
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3891
Practice Address - Country:US
Practice Address - Phone:313-996-1987
Practice Address - Fax:313-996-1935
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2020-09-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI7401000111103K00000X
MI6301015164103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist