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General NPI Number Information
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NPI Number | 1184898280
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Entity Type | Organization
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Legal Business Name | MISSI NADEAU PH.D. P.L.C.
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Dates
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Enumeration Date | 04/18/2008
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Last Update Date | 04/18/2008
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Provider Practice Location Address
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Address Line | 1735 PECK ST
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City | MUSKEGON
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State | MI
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Zip | 49441-2507
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Country | US
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Telephone | 231-722-7751
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5092
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City | MUSKEGON
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State | MI
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Zip | 49445-5092
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Country | US
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Telephone | 231-722-7751
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. MISSI NADEAU
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Credential | PH.D.
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Telephone | 231-722-7751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 6301007867
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | 6301007867
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number | 6301007867
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301007867
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License Number State | MI
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