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General NPI Number Information
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NPI Number | 1588872816
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Entity Type | Organization
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Legal Business Name | BATHERSON CONSULTANTS, LLC
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 822 W GRAND RIVER AVE
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City | BRIGHTON
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State | MI
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Zip | 48116-2303
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Country | US
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Telephone | 810-494-7111
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Fax | 810-494-7116
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Provider Business Mailing Address
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Address Line | 822 W GRAND RIVER AVE
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City | BRIGHTON
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State | MI
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Zip | 48116-2303
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Country | US
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Telephone | 810-494-7111
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Fax | 810-494-7116
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Authorized Official
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Title or Position | OWNER
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Name | MR. GARLAND W BATHERSON
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Credential | MALLP
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Telephone | 810-494-7111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | 6301006275
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License Number State | MI
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