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General NPI Number Information
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NPI Number | 1831540525
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL ASSESSMENT & COUNSELINGSPECIALISTS OF SOUTH CENTRAL MICH
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Dates
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Enumeration Date | 06/24/2016
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Last Update Date | 06/24/2016
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Provider Practice Location Address
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Address Line | 28 W CHICAGO ST SUITE 3G
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City | COLDWATER
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State | MI
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Zip | 49036-1677
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Country | US
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Telephone | 517-677-9224
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Fax |
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Provider Business Mailing Address
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Address Line | 1131 N OSSEO RD
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City | HILLSDALE
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State | MI
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Zip | 49242-9714
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Country | US
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Telephone | 517-523-3695
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Fax | 517-523-3311
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | SHAWN TALBOT
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Credential | PHD
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Telephone | 517-677-9224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | 6301015040
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301015040
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License Number State | MI
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