Healthcare Provider Details

I. General information

NPI: 1235569013
Provider Name (Legal Business Name): JUDSON CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 W 13 MILE RD
ROYAL OAK MI
48073-6515
US

IV. Provider business mailing address

4410 W 13 MILE RD
ROYAL OAK MI
48073-6515
US

V. Phone/Fax

Practice location:
  • Phone: 248-549-4339
  • Fax: 248-549-8955
Mailing address:
  • Phone: 248-549-4339
  • Fax: 248-549-8955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CHONDELLA RENEE LINDSLEY
Title or Position: CERTIFIED MEDICAL BILLER AND CODER
Credential:
Phone: 248-554-6362