MEDICARE: BATHERSON CONSULTANTS, LLC

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	103TF0000X	Family Psychologist	6301006275	MI

General Provider Information

NPI Number	:	1588872816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BATHERSON CONSULTANTS, LLC

Provider Business Mailing Address
First Line	:	822 W GRAND RIVER AVE
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48116-2303
Country	:	US
Telephone Number	:	810-494-7111
Fax Number	:	810-494-7116

Provider Business Practice Location Address
First Line	:	822 W GRAND RIVER AVE
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48116-2303
Country	:	US
Telephone Number	:	810-494-7111
Fax Number	:	810-494-7116

Authorized Official
Title or Position	:	OWNER
Name	:	MR. GARLAND W BATHERSON
Credential	:	MALLP
Telephone Number	:	810-494-7111

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	08/22/2020

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