Provider Demographics
NPI:1447389333
Name:DEHORN, ALLAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:
Last Name:DEHORN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N OLD WOODWARD AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-1324
Mailing Address - Country:US
Mailing Address - Phone:248-723-1974
Mailing Address - Fax:148-723-1975
Practice Address - Street 1:600 N OLD WOODWARD AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-1324
Practice Address - Country:US
Practice Address - Phone:248-723-1974
Practice Address - Fax:248-723-1975
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002233103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF34664OtherBCBSM
MIOM98990Medicare ID - Type Unspecified