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General NPI Number Information
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NPI Number | 1790084556
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Entity Type | Organization
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Legal Business Name | ASSOCIATES IN HUMANISTIC PSYCHOLOGY
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Dates
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Enumeration Date | 03/19/2011
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Last Update Date | 03/19/2011
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Provider Practice Location Address
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Address Line | 25779 KELLY RD
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City | ROSEVILLE
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State | MI
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Zip | 48066-4973
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Country | US
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Telephone | 586-774-7987
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Fax |
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Provider Business Mailing Address
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Address Line | 25779 KELLY RD
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City | ROSEVILLE
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State | MI
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Zip | 48066-4973
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Country | US
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Telephone | 586-774-7987
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TERRY RUDOLPH
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Credential | PHD
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Telephone | 586-774-7987
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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 | 6301003357
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License Number State | MI
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