Provider Demographics
NPI:1184898280
Name:MISSI NADEAU PH.D. P.L.C.
Entity type:Organization
Organization Name:MISSI NADEAU PH.D. P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MISSI
Authorized Official - Middle Name:
Authorized Official - Last Name:NADEAU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:231-722-7751
Mailing Address - Street 1:PO BOX 5092
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-5092
Mailing Address - Country:US
Mailing Address - Phone:231-722-7751
Mailing Address - Fax:
Practice Address - Street 1:1735 PECK ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-2507
Practice Address - Country:US
Practice Address - Phone:231-722-7751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007867103TC2200X, 103TF0200X, 103TH0004X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty