Provider Demographics
NPI:1649600941
Name:NOVA PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:NOVA PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSALYNN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:313-719-1649
Mailing Address - Street 1:2215 GOLFVIEW DR
Mailing Address - Street 2:STE 202
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3919
Mailing Address - Country:US
Mailing Address - Phone:313-719-1649
Mailing Address - Fax:248-792-3042
Practice Address - Street 1:2215 GOLFVIEW DR
Practice Address - Street 2:STE 202
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3919
Practice Address - Country:US
Practice Address - Phone:313-719-1649
Practice Address - Fax:248-792-3042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty