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General NPI Number Information
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NPI Number | 1053535997
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Entity Type | Organization
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Legal Business Name | REJUVENATE PSYCHOLOGICAL SERVICES, PC
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 147 N MILFORD RD
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City | HIGHLAND
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State | MI
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Zip | 48357-4535
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Country | US
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Telephone | 248-937-8682
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Fax |
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Provider Business Mailing Address
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Address Line | 9110 TWIN LAKES DR
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City | WHITE LAKE
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State | MI
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Zip | 48386-2099
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Country | US
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Telephone | 248-937-8682
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. PAMELA ANN DENEWETH
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Credential | MA, LLP
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Telephone | 248-937-8682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301011668
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License Number State | MI
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