1164735148 NPI number — ACTION NET PSYCHOLOGICAL SERVICES PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164735148 NPI number — ACTION NET PSYCHOLOGICAL SERVICES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACTION NET PSYCHOLOGICAL SERVICES PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164735148
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27600 FARMINGTON ROAD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48334-3348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-884-2187
Provider Business Mailing Address Fax Number:
248-661-2867

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27600 FARMINGTON RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
FARMINGTON HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48334-3348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-884-2187
Provider Business Practice Location Address Fax Number:
248-661-2867
Provider Enumeration Date:
07/20/2010

Additional Information

Authorized Official

Authorized Official Last Name:
AJO
Authorized Official First Name:
SALMA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
DIRECTOE
Authorized Official Telephone Number:
248-884-2187

Provider Taxonomy Codes

  • Taxonomy code: 252Y00000X , with the licence number:  6301009737 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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