Provider Demographics
NPI:1972756351
Name:PINTAR PSYCHOLOGICAL SERVICES, PC
Entity Type:Organization
Organization Name:PINTAR PSYCHOLOGICAL SERVICES, PC
Other - Org Name:THE LIGHTHOUSE NEUROLOGICAL REHABILIATION CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PINTAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:231-714-7054
Mailing Address - Street 1:12719 S WEST BAY SHORE DR
Mailing Address - Street 2:SUITE #9
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-5489
Mailing Address - Country:US
Mailing Address - Phone:231-714-7054
Mailing Address - Fax:
Practice Address - Street 1:12719 S WEST BAY SHORE DR
Practice Address - Street 2:SUITE #9
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-5489
Practice Address - Country:US
Practice Address - Phone:231-714-7054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013916251S00000X, 320700000X, 323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility