Provider Demographics
NPI:1649561846
Name:MICHIGAN HEALTH PSYCHOLOGISTS PLLC
Entity Type:Organization
Organization Name:MICHIGAN HEALTH PSYCHOLOGISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:SYTNIAK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:734-458-1750
Mailing Address - Street 1:PO BOX 6052
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-0052
Mailing Address - Country:US
Mailing Address - Phone:734-458-1750
Mailing Address - Fax:248-849-3460
Practice Address - Street 1:22255 GREENFIELD RD
Practice Address - Street 2:SUITE 500
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3710
Practice Address - Country:US
Practice Address - Phone:734-458-1750
Practice Address - Fax:248-849-3460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008904103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty