Provider Demographics
NPI:1629112420
Name:ASSOCIATED PSYCHOLOGISTS PLC
Entity Type:Organization
Organization Name:ASSOCIATED PSYCHOLOGISTS PLC
Other - Org Name:ASSOCIATED PSYCHOLOGISTS PLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:H
Authorized Official - Last Name:BOARDWAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:586-776-3366
Mailing Address - Street 1:19900 10 MILE ROAD
Mailing Address - Street 2:STE 102
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080
Mailing Address - Country:US
Mailing Address - Phone:586-776-3366
Mailing Address - Fax:586-776-3369
Practice Address - Street 1:19900 10 MILE ROAD
Practice Address - Street 2:STE 102
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080
Practice Address - Country:US
Practice Address - Phone:586-776-3366
Practice Address - Fax:586-776-3369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI2379Medicare PIN