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General NPI Number Information
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NPI Number | 1801506936
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Entity Type | Organization
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Legal Business Name | DALLAIRE PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 11/30/2022
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 1096 N CENTER RD STE 94
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City | BURTON
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State | MI
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Zip | 48509-1425
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Country | US
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Telephone | 616-439-0392
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Fax |
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Provider Business Mailing Address
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Address Line | 729 NATALIA DR
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City | DAVISON
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State | MI
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Zip | 48423-1200
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Country | US
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Telephone | 303-931-3859
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRISTIN DALLAIRE
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Credential | LLP
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Telephone | 616-439-0392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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