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General NPI Number Information
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NPI Number | 1679849988
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Entity Type | Organization
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Legal Business Name | MICHIGAN PSYCHOLOGICAL AND COUNSELING INSTITUTE PLLC
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 03/30/2012
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Provider Practice Location Address
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Address Line | 31584 SCHOOLCRAFT RD
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City | LIVONIA
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State | MI
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Zip | 48150-1843
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Country | US
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Telephone | 734-427-0060
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Fax | 734-427-0851
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Provider Business Mailing Address
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Address Line | 31584 SCHOOLCRAFT RD
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City | LIVONIA
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State | MI
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Zip | 48150-1843
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Country | US
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Telephone | 734-427-0060
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Fax | 734-427-0851
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Authorized Official
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Title or Position | CO-OWNER
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Name | MS. LISA M TESNER
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Credential | MBR
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Telephone | 734-427-0060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6401011816
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License Number State | MI
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