Provider Demographics
NPI:1689097677
Name:SILLER, JOHN JOSEPH JR (MA LLP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JOSEPH
Last Name:SILLER
Suffix:JR
Gender:M
Credentials:MA LLP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:882 OAKMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-3710
Mailing Address - Country:US
Mailing Address - Phone:313-961-4890
Mailing Address - Fax:313-883-6206
Practice Address - Street 1:35 W HURON ST
Practice Address - Street 2:SUITE 10 SOUTH
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2120
Practice Address - Country:US
Practice Address - Phone:248-335-0632
Practice Address - Fax:248-335-1067
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6301005323103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical