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General NPI Number Information
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NPI Number | 1255990685
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Entity Type | Organization
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Legal Business Name | BEACON PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 06/10/2019
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Last Update Date | 06/10/2019
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Provider Practice Location Address
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Address Line | 33150 SCHOOLCRAFT RD STE L03
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City | LIVONIA
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State | MI
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Zip | 48150-1631
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Country | US
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Telephone | 248-497-3411
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Fax |
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Provider Business Mailing Address
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Address Line | 195 SHINNECOCK DR
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City | BRIGHTON
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State | MI
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Zip | 48114-8832
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LIMITED LICENSED PSYCHOLOGIST
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Name | KATHRYN STARON
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Credential |
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Telephone | 248-497-3411
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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 |
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License Number State |
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