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General NPI Number Information
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NPI Number | 1477906303
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Entity Type | Organization
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Legal Business Name | INSIDE OUT RECOVERY LLC
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Dates
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Enumeration Date | 07/15/2016
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Last Update Date | 07/25/2016
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Provider Practice Location Address
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Address Line | 25418 PARSONS DR
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City | SOUTHFIELD
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State | MI
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Zip | 48075-1757
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Country | US
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Telephone | 313-874-8702
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Fax |
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Provider Business Mailing Address
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Address Line | 25418 PARSONS DR
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City | SOUTHFIELD
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State | MI
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Zip | 48075-1757
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Country | US
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Telephone | 313-874-8702
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BILLY R THOMPSON SR.
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Credential | PHD
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Telephone | 313-874-8702
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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 | 6301012987
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License Number State | MI
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