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General NPI Number Information
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NPI Number | 1265706840
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Entity Type | Organization
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Legal Business Name | MARK DENISON PHD, PC, INC
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Dates
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Enumeration Date | 02/29/2012
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Last Update Date | 03/16/2012
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Provider Practice Location Address
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Address Line | 36359 HARPER AVE SUITE A
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48035-2958
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Country | US
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Telephone | 586-792-5770
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Fax |
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Provider Business Mailing Address
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Address Line | 36359 HARPER AVE SUITE A
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48035-2958
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Country | US
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Telephone | 586-792-5770
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK DENISON
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Credential | PHD
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Telephone | 586-792-5770
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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 | 6301005775
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License Number State | MI
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