Healthcare Provider Details

I. General information

NPI: 1679085112
Provider Name (Legal Business Name): ARBOR PSYCHOLOGY GROUP NORTH CAMPUS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 PLYMOUTH RD STE 105
ANN ARBOR MI
48105-3205
US

IV. Provider business mailing address

2814 BRIARCLIFF ST
ANN ARBOR MI
48105-1431
US

V. Phone/Fax

Practice location:
  • Phone: 216-798-2837
  • Fax:
Mailing address:
  • Phone: 216-798-2837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6301016458
License Number StateMI

VIII. Authorized Official

Name: DR. BETH PEARSON
Title or Position: CLINICAL PSYCHOLOGIST/DIRECTOR
Credential:
Phone: 216-798-2837