1841448628 NPI number — A & A PSYCHOTHERAPY ASSOCIATES PC

Table of content: (NPI 1841448628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841448628 NPI number — A & A PSYCHOTHERAPY ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A & A PSYCHOTHERAPY ASSOCIATES PC
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:
1841448628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 564
Provider Second Line Business Mailing Address:
A & A PSYCHOTHERAPY ASSOCIATES PC
Provider Business Mailing Address City Name:
OKEMOS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48805-0564
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-349-4111
Provider Business Mailing Address Fax Number:
517-347-6999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4211 OKEMOS ROAD
Provider Second Line Business Practice Location Address:
SUITE #1 A & A PSYCHOTHERAPY ASSOCIATES PC
Provider Business Practice Location Address City Name:
OKEMOS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48864-3287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-349-4111
Provider Business Practice Location Address Fax Number:
517-347-6999
Provider Enumeration Date:
09/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ARELLANO LOPEZ
Authorized Official First Name:
JUAN
Authorized Official Middle Name:
JOSE
Authorized Official Title or Position:
PSYCHOTHERAPIST & PRESIDENT OF CORP
Authorized Official Telephone Number:
517-349-4111

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6801016329 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 4101005356 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0C36306 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com