Healthcare Provider Details

I. General information

NPI: 1184852667
Provider Name (Legal Business Name): DEARBORN PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 N TELEGRAPH RD
DEARBORN MI
48128-2213
US

IV. Provider business mailing address

2220 N TELEGRAPH RD
DEARBORN MI
48128-2213
US

V. Phone/Fax

Practice location:
  • Phone: 248-217-1685
  • Fax:
Mailing address:
  • Phone: 248-217-1685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6301013481
License Number StateMI

VIII. Authorized Official

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