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General NPI Number Information
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NPI Number | 1629112420
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Entity Type | Organization
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Legal Business Name | ASSOCIATED PSYCHOLOGISTS PLC
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 06/05/2019
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Provider Practice Location Address
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Address Line | 19900 10 MILE ROAD STE 102
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City | ST CLAIR SHORES
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State | MI
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Zip | 48080
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Country | US
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Telephone | 586-776-3366
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Fax | 586-776-3369
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Provider Business Mailing Address
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Address Line | 19900 10 MILE ROAD STE 102
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City | ST CLAIR SHORES
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State | MI
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Zip | 48080
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Country | US
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Telephone | 586-776-3366
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Fax | 586-776-3369
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Authorized Official
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Title or Position | OWNER
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Name | DR. RONALD H BOARDWAY
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Credential | PH.D
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Telephone | 586-776-3366
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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 |
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License Number State |
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