Provider Demographics
NPI:1750087425
Name:DMG PSYCHOLOGY
Entity type:Organization
Organization Name:DMG PSYCHOLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MASTER'S LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOETSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LLP
Authorized Official - Phone:313-528-9146
Mailing Address - Street 1:3070 LINDENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1312
Mailing Address - Country:US
Mailing Address - Phone:313-528-9146
Mailing Address - Fax:
Practice Address - Street 1:23400 PARK ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2545
Practice Address - Country:US
Practice Address - Phone:313-528-9146
Practice Address - Fax:313-558-8384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12754218OtherCAQH