Provider Demographics
NPI:1518329671
Name:PSYCHOLOGICAL PROFESSIONAL SERVICES
Entity Type:Organization
Organization Name:PSYCHOLOGICAL PROFESSIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LLP
Authorized Official - Phone:586-231-0306
Mailing Address - Street 1:38800 GARFIELD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6619
Mailing Address - Country:US
Mailing Address - Phone:586-231-0306
Mailing Address - Fax:586-231-0307
Practice Address - Street 1:38800 GARFIELD RD STE 100
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6619
Practice Address - Country:US
Practice Address - Phone:586-231-0306
Practice Address - Fax:586-231-0307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-27
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011383103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty