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General NPI Number Information
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NPI Number | 1306896956
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Entity Type | Organization
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Legal Business Name | LIST PSYCHOLOGICAL SERVICES, PLC
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 12/27/2016
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Provider Practice Location Address
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Address Line | 624 W NEPESSING ST SUITE 300
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City | LAPEER
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State | MI
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Zip | 48446-2090
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Country | US
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Telephone | 810-667-4500
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Fax | 810-667-4500
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Provider Business Mailing Address
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Address Line | 443 N STATE ST
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City | CARO
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State | MI
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Zip | 48723-1539
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Country | US
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Telephone | 989-672-6160
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Fax | 989-672-5649
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Authorized Official
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Title or Position | COO
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Name | JACQUELINE THOMPSON
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Credential |
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Telephone | 989-672-6160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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