MEDICARE: JASON DAVID MAJCHRZAK M.S., T.L.L.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	7401000111	MI
2	103T00000X	Psychologist	6301015164	MI

General Provider Information

NPI Number	:	1336495746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON DAVID MAJCHRZAK M.S., T.L.L.P.

Provider Business Mailing Address
First Line	:	26901 BEAUMONT BLVD STE 3D
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-3849
Country	:	US
Telephone Number	:	947-522-1863
Fax Number	:	947-522-0307

Provider Business Practice Location Address
First Line	:	18501 ROTUNDA DR STE 100
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-3891
Country	:	US
Telephone Number	:	313-996-1987
Fax Number	:	313-996-1935

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2012
Last Update Date	:	09/29/2020

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