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NPI Code Detail

MEDICARE: MARY FRANK PSYCHOLOGIST

MEDICARE: MARY FRANK PSYCHOLOGIST
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
1103T00000XPsychologist6301008271MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
161-30054OTHERMIPHP ID#

General Provider Information

NPI Number : 1679500243
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY FRANK PSYCHOLOGIST
Provider Business Mailing Address
First Line : 5675 FAIRVIEW ST
Second Line :
City : STEVENSVILLE
State : MI
Zip : 49127-1033
Country : US
Telephone Number : 269-429-7727
Fax Number : 269-429-5754
Provider Business Practice Location Address
First Line : 5675 FAIRVIEW ST
Second Line :
City : STEVENSVILLE
State : MI
Zip : 49127-1033
Country : US
Telephone Number : 269-429-7727
Fax Number : 269-429-5754
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2006
Last Update Date : 07/08/2007

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Directions to “ MARY FRANK PSYCHOLOGIST” Practice Location

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