Provider Demographics
NPI:1609542646
Name:THE SLYCHOLOGY DEPARTMENT LLC
Entity Type:Organization
Organization Name:THE SLYCHOLOGY DEPARTMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BLACKSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:248-763-9194
Mailing Address - Street 1:9237 BECKER AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1563
Mailing Address - Country:US
Mailing Address - Phone:248-763-9194
Mailing Address - Fax:
Practice Address - Street 1:32770 GRAND RIVER AVE STE 206B
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-3159
Practice Address - Country:US
Practice Address - Phone:248-763-9194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-19
Last Update Date:2021-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health