Provider Demographics
NPI:1336761147
Name:MICHIGAN SCHOOL OF PSYCHOLOGY
Entity Type:Organization
Organization Name:MICHIGAN SCHOOL OF PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-476-1122
Mailing Address - Street 1:26811 ORCHARD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-4512
Mailing Address - Country:US
Mailing Address - Phone:248-476-1122
Mailing Address - Fax:248-476-1125
Practice Address - Street 1:26811 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-4512
Practice Address - Country:US
Practice Address - Phone:248-476-1122
Practice Address - Fax:248-476-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty