Provider Demographics
NPI:1609105469
Name:PRIMARY CARE PSYCHOLOGY PLLC
Entity Type:Organization
Organization Name:PRIMARY CARE PSYCHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:269-375-6079
Mailing Address - Street 1:4625 BECKLEY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-7948
Mailing Address - Country:US
Mailing Address - Phone:269-375-6079
Mailing Address - Fax:269-375-6078
Practice Address - Street 1:4625 BECKLEY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-7948
Practice Address - Country:US
Practice Address - Phone:269-375-6079
Practice Address - Fax:269-375-6078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty