Provider Demographics
NPI:1851865968
Name:CIRCLE OF LIFE PSYCHOLOGICAL SERVICES, PC
Entity Type:Organization
Organization Name:CIRCLE OF LIFE PSYCHOLOGICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KEY-CARNIAK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LLP, LLMFT
Authorized Official - Phone:248-420-6742
Mailing Address - Street 1:150 LANGE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-4667
Mailing Address - Country:US
Mailing Address - Phone:248-420-6742
Mailing Address - Fax:
Practice Address - Street 1:1700 W BIG BEAVER RD STE 200
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3524
Practice Address - Country:US
Practice Address - Phone:248-420-6742
Practice Address - Fax:248-243-8668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health