Provider Demographics
NPI:1457542946
Name:JAMES KEILLOR PHD PC
Entity Type:Organization
Organization Name:JAMES KEILLOR PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:KEILLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-398-3050
Mailing Address - Street 1:217 KNOWLES ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2767
Mailing Address - Country:US
Mailing Address - Phone:248-398-3050
Mailing Address - Fax:586-286-4739
Practice Address - Street 1:217 KNOWLES ST
Practice Address - Street 2:SUITE 110
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2767
Practice Address - Country:US
Practice Address - Phone:248-398-3050
Practice Address - Fax:586-286-4739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301001047103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N90830Medicare PIN