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General NPI Number Information
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NPI Number | 1770225906
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Entity Type | Organization
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Legal Business Name | COGNITIVE INSIGHT CENTER, INC
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Dates
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Enumeration Date | 04/08/2022
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Last Update Date | 04/08/2022
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Provider Practice Location Address
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Address Line | 26789 WOODWARD AVE STE 209
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City | HUNTINGTON WOODS
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State | MI
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Zip | 48070-1334
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Country | US
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Telephone | 248-629-0079
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Fax | 248-939-9569
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Provider Business Mailing Address
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Address Line | 26789 WOODWARD AVE STE 209
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City | HUNTINGTON WOODS
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State | MI
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Zip | 48070-1334
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Country | US
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Telephone | 248-629-0079
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Fax | 248-939-9569
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Authorized Official
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Title or Position | FOUNDER/PRESIDENT
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Name | DR. TOBY KELLK-HAMANN
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Credential | PSYD
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Telephone | 248-629-0079
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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Taxonomy #3
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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Taxonomy #4
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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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