Healthcare Provider Details

I. General information

NPI: 1841448628
Provider Name (Legal Business Name): A & A PSYCHOTHERAPY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 OKEMOS ROAD SUITE #1 A & A PSYCHOTHERAPY ASSOCIATES PC
OKEMOS MI
48864-3287
US

IV. Provider business mailing address

PO BOX 564 A & A PSYCHOTHERAPY ASSOCIATES PC
OKEMOS MI
48805-0564
US

V. Phone/Fax

Practice location:
  • Phone: 517-349-4111
  • Fax: 517-347-6999
Mailing address:
  • Phone: 517-349-4111
  • Fax: 517-347-6999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801016329
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101005356
License Number StateMI

VIII. Authorized Official

Name: MR. JUAN JOSE ARELLANO LOPEZ
Title or Position: PSYCHOTHERAPIST & PRESIDENT OF CORP
Credential: MSW MA LMSW LMFT
Phone: 517-349-4111