Provider Demographics
NPI:1265603716
Name:WILLIAM C IRVING PHD PLLC
Entity type:Organization
Organization Name:WILLIAM C IRVING PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:I.
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-443-4402
Mailing Address - Street 1:22811 GREATER MACK AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2021
Mailing Address - Country:US
Mailing Address - Phone:586-443-4402
Mailing Address - Fax:586-443-4412
Practice Address - Street 1:22811 GREATER MACK AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2021
Practice Address - Country:US
Practice Address - Phone:586-443-4402
Practice Address - Fax:586-443-4412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Single Specialty