Provider Demographics
NPI:1831540525
Name:PSYCHOLOGICAL ASSESSMENT & COUNSELINGSPECIALISTS OF SOUTH CENTRAL MICH
Entity type:Organization
Organization Name:PSYCHOLOGICAL ASSESSMENT & COUNSELINGSPECIALISTS OF SOUTH CENTRAL MICH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:TALBOT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:517-677-9224
Mailing Address - Street 1:1131 N OSSEO RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-9714
Mailing Address - Country:US
Mailing Address - Phone:517-523-3695
Mailing Address - Fax:517-523-3311
Practice Address - Street 1:28 W CHICAGO ST
Practice Address - Street 2:SUITE 3G
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-1677
Practice Address - Country:US
Practice Address - Phone:517-677-9224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015040103TF0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty