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General NPI Number Information
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NPI Number | 1487712642
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Entity Type | Organization
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Legal Business Name | BAY PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 236 1/2 E FRONT ST
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-2526
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Country | US
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Telephone | 231-946-6488
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Fax | 231-275-0153
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Provider Business Mailing Address
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Address Line | PO BOX 4249
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City | TRAVERSE CITY
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State | MI
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Zip | 49685-4249
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Country | US
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Telephone | 231-946-6488
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Fax | 231-275-0153
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. JENNIFER J. SOWLE
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Credential | PHD
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Telephone | 231-946-6488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301007636
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License Number State | MI
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