Provider Demographics
NPI:1841448628
Name:A & A PSYCHOTHERAPY ASSOCIATES PC
Entity type:Organization
Organization Name:A & A PSYCHOTHERAPY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST & PRESIDENT OF CORP
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:ARELLANO LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW MA LMSW LMFT
Authorized Official - Phone:517-349-4111
Mailing Address - Street 1:PO BOX 564
Mailing Address - Street 2:A & A PSYCHOTHERAPY ASSOCIATES PC
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48805-0564
Mailing Address - Country:US
Mailing Address - Phone:517-349-4111
Mailing Address - Fax:517-347-6999
Practice Address - Street 1:4211 OKEMOS ROAD
Practice Address - Street 2:SUITE #1 A & A PSYCHOTHERAPY ASSOCIATES PC
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3287
Practice Address - Country:US
Practice Address - Phone:517-349-4111
Practice Address - Fax:517-347-6999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101005356106H00000X
MI68010163291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C36306Medicaid
MI0C36306Medicaid
MI0C36306Medicare PIN