Provider Demographics
NPI:1710026513
Name:INNERVISIONS PYSCHOLOGICAL SERVICES, PLLC.
Entity Type:Organization
Organization Name:INNERVISIONS PYSCHOLOGICAL SERVICES, PLLC.
Other - Org Name:JAMES REED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:517-381-1700
Mailing Address - Street 1:4121 OKEMOS RD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3220
Mailing Address - Country:US
Mailing Address - Phone:517-381-1700
Mailing Address - Fax:517-381-1703
Practice Address - Street 1:4121 OKEMOS RD
Practice Address - Street 2:SUITE 15
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3220
Practice Address - Country:US
Practice Address - Phone:517-381-1700
Practice Address - Fax:517-381-1703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005840103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7670553OtherAETNA
MI367325OtherTRICARE/MHN
MIOP40210Medicare PIN