Provider Demographics
NPI:1801506936
Name:DALLAIRE PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:DALLAIRE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DALLAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:616-439-0392
Mailing Address - Street 1:729 NATALIA DR
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-1200
Mailing Address - Country:US
Mailing Address - Phone:303-931-3859
Mailing Address - Fax:
Practice Address - Street 1:1096 N CENTER RD STE 94
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1425
Practice Address - Country:US
Practice Address - Phone:616-439-0392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)