Provider Demographics
NPI:1437260072
Name:GENESEE PSYCHOLOGICAL RESOURCES, P.C.
Entity Type:Organization
Organization Name:GENESEE PSYCHOLOGICAL RESOURCES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:VORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:810-732-6030
Mailing Address - Street 1:3095 S DYE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1001
Mailing Address - Country:US
Mailing Address - Phone:810-732-6030
Mailing Address - Fax:810-732-0551
Practice Address - Street 1:3095 S DYE RD
Practice Address - Street 2:SUITE A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1001
Practice Address - Country:US
Practice Address - Phone:810-732-6030
Practice Address - Fax:810-732-0551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI001720103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN2980002Medicare ID - Type Unspecified