Provider Demographics
NPI:1811907587
Name:APX PSYCHOLOGICAL PC
Entity type:Organization
Organization Name:APX PSYCHOLOGICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAVANAUGH-WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:810-664-8060
Mailing Address - Street 1:PO BOX 985
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-0985
Mailing Address - Country:US
Mailing Address - Phone:810-664-8060
Mailing Address - Fax:810-245-8352
Practice Address - Street 1:700 S MAIN ST
Practice Address - Street 2:SUITE 208
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3077
Practice Address - Country:US
Practice Address - Phone:810-664-8060
Practice Address - Fax:810-245-8352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
160412OtherVALUE OPTIONS