Provider Demographics
NPI:1952723330
Name:PSYCHOLOGICAL AND SPIRITUAL SERVICES
Entity Type:Organization
Organization Name:PSYCHOLOGICAL AND SPIRITUAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ELWART
Authorized Official - Suffix:
Authorized Official - Credentials:PSYS, LLP
Authorized Official - Phone:248-545-8510
Mailing Address - Street 1:2007 ROSELAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-5014
Mailing Address - Country:US
Mailing Address - Phone:248-545-8510
Mailing Address - Fax:248-440-7288
Practice Address - Street 1:2007 ROSELAND AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-5014
Practice Address - Country:US
Practice Address - Phone:248-545-8510
Practice Address - Fax:248-440-7288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty