Provider Demographics
NPI:1679849988
Name:MICHIGAN PSYCHOLOGICAL AND COUNSELING INSTITUTE PLLC
Entity Type:Organization
Organization Name:MICHIGAN PSYCHOLOGICAL AND COUNSELING INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TESNER
Authorized Official - Suffix:
Authorized Official - Credentials:MBR
Authorized Official - Phone:734-427-0060
Mailing Address - Street 1:31584 SCHOOLCRAFT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1843
Mailing Address - Country:US
Mailing Address - Phone:734-427-0060
Mailing Address - Fax:734-427-0851
Practice Address - Street 1:31584 SCHOOLCRAFT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1843
Practice Address - Country:US
Practice Address - Phone:734-427-0060
Practice Address - Fax:734-427-0851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011816251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health