Provider Demographics
NPI:1356376487
Name:DELTA PSYCHOLOGICAL & NEUROBEHAVIORAL SERVICES, LLC
Entity type:Organization
Organization Name:DELTA PSYCHOLOGICAL & NEUROBEHAVIORAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER CLINICAL PRACTICE
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LMSW ACSW
Authorized Official - Phone:989-895-0788
Mailing Address - Street 1:114 TUSCOLA
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-6995
Mailing Address - Country:US
Mailing Address - Phone:989-895-0788
Mailing Address - Fax:989-895-0799
Practice Address - Street 1:114 TUSCOLA
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6995
Practice Address - Country:US
Practice Address - Phone:989-895-0788
Practice Address - Fax:989-895-0799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P16580Medicare PIN