Provider Demographics
NPI:1679210454
Name:EZ TELEPSYCH LLC
Entity Type:Organization
Organization Name:EZ TELEPSYCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:JOZ
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, APRN
Authorized Official - Phone:248-983-1070
Mailing Address - Street 1:455 E EISENHOWER PKWY STE 300-1016
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-3356
Mailing Address - Country:US
Mailing Address - Phone:248-983-1070
Mailing Address - Fax:248-780-3805
Practice Address - Street 1:455 E EISENHOWER PKWY STE 300-1016
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-3356
Practice Address - Country:US
Practice Address - Phone:248-983-1070
Practice Address - Fax:248-780-3805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-13
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty