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General NPI Number Information
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NPI Number | 1407910854
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL AND CONSULTATION SERVICES PC
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 07/06/2020
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Provider Practice Location Address
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Address Line | 4123 OKEMOS RD STE 15
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City | OKEMOS
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State | MI
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Zip | 48864-2818
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Country | US
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Telephone | 517-336-7366
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Fax | 517-336-0808
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Provider Business Mailing Address
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Address Line | PO BOX 4455
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City | EAST LANSING
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State | MI
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Zip | 48826-4455
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Country | US
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Telephone | 517-336-7366
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Fax | 517-336-0808
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST, PRESIDENT
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Name | DR. PRISCILLA WADE
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Credential | PH.D.
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Telephone | 517-336-7366
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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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