Healthcare Provider Details

I. General information

NPI: 1689211153
Provider Name (Legal Business Name): COMPREHENSIVE PSYCHOLOGICAL SERVICE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 EAST LANSING DRIVE
EAST LANSING MI
48823
US

IV. Provider business mailing address

2720 EAST LANSING DRIVE
EAST LANSING MI
48823
US

V. Phone/Fax

Practice location:
  • Phone: 517-337-2900
  • Fax: 517-351-1279
Mailing address:
  • Phone: 517-337-2900
  • Fax: 517-351-1279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: J. KEITH OSTIEN
Title or Position: RESIDENT AGENT/ OWNER
Credential: PHD
Phone: 517-337-2900