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NPI Code Detail

MEDICARE: MS. JOYCE OBERMEYER PINES M.A.

MEDICARE: MS. JOYCE OBERMEYER PINES M.A.
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
1103T00000XPsychologistP520447650254MI
2103TC1900XCounseling Psychologist6301014740MI
3101YA0400XAddiction (Substance Use Disorder) CounselorC-02759MI

General Provider Information

NPI Number : 1326341215
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JOYCE OBERMEYER PINES M.A.
Provider Business Mailing Address
First Line : 5464 HOLIDAY TER
Second Line :
City : KALAMAZOO
State : MI
Zip : 49009-2147
Country : US
Telephone Number : 269-488-5905
Fax Number : 269-488-5906
Provider Business Practice Location Address
First Line : 5464 HOLIDAY TER
Second Line :
City : KALAMAZOO
State : MI
Zip : 49009-2147
Country : US
Telephone Number : 269-488-5905
Fax Number : 269-488-5906
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2010
Last Update Date : 04/18/2016

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