Provider Demographics
NPI:1932241866
Name:PSYCHOLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:PSYCHOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:TOBIN
Authorized Official - Last Name:SULIER
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:269-983-4751
Mailing Address - Street 1:2095 NILES RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2473
Mailing Address - Country:US
Mailing Address - Phone:269-985-4751
Mailing Address - Fax:269-983-0803
Practice Address - Street 1:2095 NILES RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2473
Practice Address - Country:US
Practice Address - Phone:269-985-4751
Practice Address - Fax:269-983-0803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009442103T00000X
MI6301012953103T00000X
MI6301007140103T00000X
MI6301003207103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty