Provider Demographics
NPI:1790817294
Name:ALLAN B DEHORN, PHD, PLLC
Entity Type:Organization
Organization Name:ALLAN B DEHORN, PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:DEHORN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-723-1974
Mailing Address - Street 1:600 N OLD WOODWARD AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-1324
Mailing Address - Country:US
Mailing Address - Phone:248-723-1974
Mailing Address - Fax:248-723-1975
Practice Address - Street 1:600 N OLD WOODWARD AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-1324
Practice Address - Country:US
Practice Address - Phone:248-723-1974
Practice Address - Fax:248-723-1975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002233103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF34664OtherBCBSM
MIOF34664OtherBCBSM