Provider Demographics
NPI:1407910854
Name:PSYCHOLOGICAL AND CONSULTATION SERVICES PC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL AND CONSULTATION SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:517-336-7366
Mailing Address - Street 1:PO BOX 4455
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48826-4455
Mailing Address - Country:US
Mailing Address - Phone:517-336-7366
Mailing Address - Fax:517-336-0808
Practice Address - Street 1:4123 OKEMOS RD STE 15
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2818
Practice Address - Country:US
Practice Address - Phone:517-336-7366
Practice Address - Fax:517-336-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1871650291OtherBANKER'S FIDELITY LIFE INSURANCE
MI1871650291OtherTRICARE
MI1871650291OtherUNITED HEALTHCARE
MI1871650291OtherCOFINITY
MI900080140OtherPRIORITY HEALTH
MI11291411OtherB;UE CROSS TRUST
MI68OC346780OtherBCBSM
MIA185414OtherBEACON HEALTH OPTIONS INC
MI200000006054OtherPHYSICIAN HEALTH PLAN
MIR1016708OtherMCLAREN
MI1871650291OtherPARAIRIE STATES ENTERPRISES INC