Provider Demographics
NPI:1023261104
Name:DAVID L. THAYER, PSY.D.,P.C.
Entity type:Organization
Organization Name:DAVID L. THAYER, PSY.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:THAYER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD,PC
Authorized Official - Phone:269-501-3493
Mailing Address - Street 1:821 W SOUTH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-4684
Mailing Address - Country:US
Mailing Address - Phone:269-501-3493
Mailing Address - Fax:269-344-5973
Practice Address - Street 1:821 W SOUTH ST
Practice Address - Street 2:SUITE D
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-4684
Practice Address - Country:US
Practice Address - Phone:269-501-3493
Practice Address - Fax:269-344-5973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty