Provider Demographics
NPI:1952117566
Name:PSYCHE CLINICAL LLC
Entity type:Organization
Organization Name:PSYCHE CLINICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, OPERATIONS & STRATEGY
Authorized Official - Prefix:
Authorized Official - First Name:ZACH
Authorized Official - Middle Name:
Authorized Official - Last Name:DONISCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-986-5733
Mailing Address - Street 1:34505 W 12 MILE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3286
Mailing Address - Country:US
Mailing Address - Phone:248-986-5733
Mailing Address - Fax:
Practice Address - Street 1:34505 W 12 MILE RD STE 210
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3286
Practice Address - Country:US
Practice Address - Phone:248-986-5733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-09
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health