Provider Demographics
NPI:1790086114
Name:MICHIGAN NEUROPSYCHOLOGICAL SOCIETY, INC.
Entity Type:Organization
Organization Name:MICHIGAN NEUROPSYCHOLOGICAL SOCIETY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-909-8402
Mailing Address - Street 1:26555 EVERGREEN RD
Mailing Address - Street 2:SUITE # 826
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4206
Mailing Address - Country:US
Mailing Address - Phone:248-350-9559
Mailing Address - Fax:
Practice Address - Street 1:26555 EVERGREEN RD
Practice Address - Street 2:SUITE # 826
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-4206
Practice Address - Country:US
Practice Address - Phone:248-350-9559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable