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General NPI Number Information
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NPI Number | 1972862902
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Entity Type | Organization
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Legal Business Name | UNIVERSITY PEDIATRICIANS AUTISM CENTER
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Dates
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Enumeration Date | 05/11/2012
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Last Update Date | 09/29/2023
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Provider Practice Location Address
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Address Line | 21600 NOVI RD STE 800
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City | NOVI
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State | MI
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Zip | 48375-5608
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Country | US
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Telephone | 248-305-6172
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Fax | 248-305-6202
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Provider Business Mailing Address
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Address Line | 21600 NOVI RD STE 800
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City | NOVI
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State | MI
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Zip | 48375-5608
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Country | US
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Telephone | 248-305-6172
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Fax | 248-305-6202
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Authorized Official
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Title or Position | CAO
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Name | MR. MARK HARRISON
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Credential |
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Telephone | 313-745-6911
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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 | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 103TE1100X
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Taxonomy Name | Exercise & Sports Psychologist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 103TP0814X
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Taxonomy Name | Psychoanalysis Psychologist
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number |
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License Number State |
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Taxonomy #14
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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Taxonomy #15
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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