Provider Demographics
NPI:1841252186
Name:PSYCH SERVICES, LTD
Entity type:Organization
Organization Name:PSYCH SERVICES, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/ PRIMARY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:517-853-1925
Mailing Address - Street 1:809 CENTER STREET
Mailing Address - Street 2:SUITE 8A
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906
Mailing Address - Country:US
Mailing Address - Phone:517-853-1925
Mailing Address - Fax:517-853-1926
Practice Address - Street 1:2132 CEDAR ST STE 2
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-1458
Practice Address - Country:US
Practice Address - Phone:517-853-1925
Practice Address - Fax:517-853-1926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X, 103TF0200X
MI6301005619103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOC31120OtherBC BS GROUP
036126OtherVALUE OPTIONS
MI680C346730OtherBC BS
036126OtherVALUE OPTIONS
=========OtherTRICARE
MIOC31120OtherBC BS GROUP
R67028Medicare UPIN