Healthcare Provider Details

I. General information

NPI: 1831540525
Provider Name (Legal Business Name): PSYCHOLOGICAL ASSESSMENT & COUNSELINGSPECIALISTS OF SOUTH CENTRAL MICH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 06/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 W CHICAGO ST SUITE 3G
COLDWATER MI
49036-1677
US

IV. Provider business mailing address

1131 N OSSEO RD
HILLSDALE MI
49242-9714
US

V. Phone/Fax

Practice location:
  • Phone: 517-677-9224
  • Fax:
Mailing address:
  • Phone: 517-523-3695
  • Fax: 517-523-3311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number6301015040
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301015040
License Number StateMI

VIII. Authorized Official

Name: SHAWN TALBOT
Title or Position: SOLE MEMBER
Credential: PHD
Phone: 517-677-9224