Healthcare Provider Details

I. General information

NPI: 1467953349
Provider Name (Legal Business Name): PERSPECTIVES PSYCHOLOGICAL ASSOCIATES OF MIDMICHIGAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W WACKERLY ST
MIDLAND MI
48640-2791
US

IV. Provider business mailing address

104 W WACKERLY ST
MIDLAND MI
48640-2791
US

V. Phone/Fax

Practice location:
  • Phone: 989-992-6974
  • Fax:
Mailing address:
  • Phone: 989-486-3021
  • Fax: 989-486-1843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LOMBARDO
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 989-486-3021