Healthcare Provider Details

I. General information

NPI: 1215114095
Provider Name (Legal Business Name): RICHARD THOMAS JANKA PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 PLYMOUTH RD SUITE 100
PLYMOUTH MI
48170-1497
US

IV. Provider business mailing address

9397 N HAGGERTY RD
PLYMOUTH MI
48170-4622
US

V. Phone/Fax

Practice location:
  • Phone: 734-927-1201
  • Fax: 734-927-1203
Mailing address:
  • Phone: 734-927-1201
  • Fax: 734-927-1203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301013595
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: