Provider Demographics
NPI:1932600772
Name:GRAND BLANC PSYCHOLOGY PLLC
Entity Type:Organization
Organization Name:GRAND BLANC PSYCHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:STARZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LIMITED LICENSED PSY
Authorized Official - Phone:269-277-3013
Mailing Address - Street 1:8382 HOLLY RD STE 1
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1972
Mailing Address - Country:US
Mailing Address - Phone:269-277-3013
Mailing Address - Fax:833-790-2990
Practice Address - Street 1:8382 HOLLY RD STE 1
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1972
Practice Address - Country:US
Practice Address - Phone:269-277-3013
Practice Address - Fax:833-790-2990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009442103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty