Provider Demographics
NPI:1639476518
Name:SALLY PALAIAN, PH.D. P.C.
Entity Type:Organization
Organization Name:SALLY PALAIAN, PH.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PALAIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-645-5960
Mailing Address - Street 1:30400 TELEGRAPH RD
Mailing Address - Street 2:SUITE 331
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4537
Mailing Address - Country:US
Mailing Address - Phone:248-645-5960
Mailing Address - Fax:
Practice Address - Street 1:30400 TELEGRAPH RD
Practice Address - Street 2:SUITE 331
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4537
Practice Address - Country:US
Practice Address - Phone:248-645-5960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007602103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty