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General NPI Number Information
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NPI Number | 1205263308
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Entity Type | Organization
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Legal Business Name | OLIPHANT CONSULTING, INC.
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Dates
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Enumeration Date | 10/03/2013
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Last Update Date | 10/03/2013
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Provider Practice Location Address
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Address Line | 725 S ADAMS RD SUITE 241
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City | BIRMINGHAM
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State | MI
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Zip | 48009-6902
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Country | US
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Telephone | 248-924-2133
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Fax | 248-924-2599
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Provider Business Mailing Address
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Address Line | 143 CADYCENTRE 206
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City | NORTHVILLE
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State | MI
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Zip | 48167-1119
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Country | US
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Telephone | 248-924-2133
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Fax | 248-924-2599
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. JACQUELYN OLIPHANT
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Credential | PH.D.
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Telephone | 248-924-2133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301005964
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License Number State | MI
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