MEDICARE: DEARBORN PSYCHOLOGICAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist	6301013481	MI

General Provider Information

NPI Number	:	1184852667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEARBORN PSYCHOLOGICAL SERVICES

Provider Business Mailing Address
First Line	:	2220 N TELEGRAPH RD
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48128-2213
Country	:	US
Telephone Number	:	248-217-1685
Fax Number	:

Provider Business Practice Location Address
First Line	:	2220 N TELEGRAPH RD
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48128-2213
Country	:	US
Telephone Number	:	248-217-1685
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST/PARTNER/OWNER
Name	:	MR. KIRK DAVID DUNCAN
Credential	:	MS MA LLP CAAC
Telephone Number	:	248-217-1685

Provider Enumeration Date	:	06/23/2009
Last Update Date	:	06/23/2009

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