Provider Demographics
NPI:1881733210
Name:PROFESSIONAL PSYCHOLOGICAL SERVICES, P.C.
Entity type:Organization
Organization Name:PROFESSIONAL PSYCHOLOGICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:CSOTTY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:734-671-8060
Mailing Address - Street 1:23933 ALLEN RD STE 12
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-3369
Mailing Address - Country:US
Mailing Address - Phone:734-671-8060
Mailing Address - Fax:734-379-9594
Practice Address - Street 1:23933 ALLEN RD STE 12
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-3369
Practice Address - Country:US
Practice Address - Phone:734-671-8060
Practice Address - Fax:734-379-9594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI002037103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty