Provider Demographics
NPI:1972834620
Name:AGN SERVICES
Entity Type:Organization
Organization Name:AGN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:EYAL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:989-772-4702
Mailing Address - Street 1:500 S MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3100
Mailing Address - Country:US
Mailing Address - Phone:989-772-4702
Mailing Address - Fax:989-775-1507
Practice Address - Street 1:500 S MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3100
Practice Address - Country:US
Practice Address - Phone:989-772-4702
Practice Address - Fax:989-775-1507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization