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General NPI Number Information
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NPI Number | 1306376546
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Entity Type | Organization
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Legal Business Name | AGIUS PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 06/19/2017
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Last Update Date | 06/04/2018
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Provider Practice Location Address
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Address Line | 1440 TORREY RD STE E
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City | FENTON
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State | MI
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Zip | 48430
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Country | US
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Telephone | 810-288-6652
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Fax |
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Provider Business Mailing Address
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Address Line | 237 ARMSTRONG ST
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City | FENTON
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State | MI
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Zip | 48430-1728
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Country | US
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Telephone | 810-210-4894
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHNATHAN AGIUS
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Credential | LLP
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Telephone | 810-288-6652
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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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