Provider Demographics
NPI:1558594283
Name:GEORGE PSYCHOLOGICAL SERVICES PC
Entity Type:Organization
Organization Name:GEORGE PSYCHOLOGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LP
Authorized Official - Phone:313-562-6709
Mailing Address - Street 1:2314 MONROE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3045
Mailing Address - Country:US
Mailing Address - Phone:313-562-6709
Mailing Address - Fax:313-562-0880
Practice Address - Street 1:2314 MONROE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3045
Practice Address - Country:US
Practice Address - Phone:313-562-6709
Practice Address - Fax:313-562-0880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1367103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty