Healthcare Provider Details

I. General information

NPI: 1841252186
Provider Name (Legal Business Name): PSYCH SERVICES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2132 CEDAR ST STE 2
HOLT MI
48842-1458
US

IV. Provider business mailing address

809 CENTER STREET SUITE 8A
LANSING MI
48906
US

V. Phone/Fax

Practice location:
  • Phone: 517-853-1925
  • Fax: 517-853-1926
Mailing address:
  • Phone: 517-853-1925
  • Fax: 517-853-1926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6301005619
License Number StateMI

VIII. Authorized Official

Name: EDWARD C COOK
Title or Position: DOCTOR/ PRIMARY OFFICER
Credential: PHD
Phone: 517-853-1925