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General NPI Number Information
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NPI Number | 1184021834
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PSYCHOLOGICAL AND REHABILITATION SERVICES, PC
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Dates
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Enumeration Date | 11/24/2014
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 302 S WAVERLY RD
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City | LANSING
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State | MI
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Zip | 48917-3631
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Country | US
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Telephone | 517-321-5900
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Fax |
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Provider Business Mailing Address
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Address Line | 302 S WAVERLY RD SUITE1
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City | LANSING
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State | MI
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Zip | 48917-3631
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Country | US
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Telephone | 517-321-5900
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Fax |
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Authorized Official
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Title or Position | CLINICAL THERAPIST
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Name | JOHN P DOWLING
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Credential | MA, LPC.
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Telephone | 517-321-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6401003899
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License Number State | MI
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