MEDICARE: PROF. ANDREW M BARCLAY PH.D..

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	103T00000X	Psychologist	6301007781	MI

General Provider Information

NPI Number	:	1912177932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. ANDREW M BARCLAY PH.D..

Provider Business Mailing Address
First Line	:	9029 W SCENIC LAKE DR
Second Line	:
City	:	LAINGSBURG
State	:	MI
Zip	:	48848-8785
Country	:	US
Telephone Number	:	517-651-2661
Fax Number	:	517-651-9632

Provider Business Practice Location Address
First Line	:	9029 W SCENIC LAKE DR
Second Line	:
City	:	LAINGSBURG
State	:	MI
Zip	:	48848-8785
Country	:	US
Telephone Number	:	517-651-2661
Fax Number	:	517-651-9632

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

Provider Enumeration Date	:	03/05/2008
Last Update Date	:	03/05/2008

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