Provider Demographics
NPI:1912273095
Name:CHANGING PERCEPTIONS THERAPY
Entity Type:Organization
Organization Name:CHANGING PERCEPTIONS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CONRAD-GARRISI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LLP
Authorized Official - Phone:586-226-8440
Mailing Address - Street 1:18557 CANAL RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5821
Mailing Address - Country:US
Mailing Address - Phone:586-226-8440
Mailing Address - Fax:586-226-8470
Practice Address - Street 1:18557 CANAL RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-5821
Practice Address - Country:US
Practice Address - Phone:586-226-8440
Practice Address - Fax:586-226-8470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014870251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health