| Burdette And Doss Psychological Services Lc | |
|
17352 W 12 Mile Rd Suite 100 Southfield MI 48076-2119 | |
| (248) 559-0730 | |
| (248) 569-7626 |
| Full Name | Burdette And Doss Psychological Services Lc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 17352 W 12 Mile Rd, Southfield, Michigan |
| Authorized Official Name and Position | Barbara Ann Elisabeth Tysell (ADMINISTRATIVE DIRECTOR) |
| Authorized Official Contact | 2485590730 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Burdette And Doss Psychological Services Lc 17352 W 12 Mile Rd Suite 100 Southfield MI 48076-2119 Ph: (248) 559-0730 | Burdette And Doss Psychological Services Lc 17352 W 12 Mile Rd Suite 100 Southfield MI 48076-2119 Ph: (248) 559-0730 |
| NPI Number | 1073647731 |
|---|---|
| Provider Enumeration Date | 03/15/2007 |
| Last Update Date | 10/28/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073647731 | NPI | - | NPPES |
| 750910921 | Other | MI | BCBS TRADITIONAL CODE |
| 20700 | Other | MI | BCBS SUB AB AND MGD CARE |
| 7509109210 | Other | MI | BCBS NASCO IDENTIFIER |
| 1316097488 | Other | MI | NPPESJAMES A. COWLEY NPI |
| 26 0 F3 2684 0 | Other | MI | NASCO GROUP TRACKING ID |
| 38314498 | Other | MI | HAP PROVIDER ID |
| 7509109210 | Other | MI | VALUEOPTIONS |
| 0911921 | Other | MI | BCBS PROVIDER ID MDS |
| 0913921 | Other | MI | BCBS PROVIDER ID MASTERS |
| 630534 | Other | MI | STATE SUBSTANCE ABUSE LIC |
| 0912921 | Other | MI | BCBS PROVIDER ID PHDS |
| 10921 | Other | MI | BCBS MANAGED CARE CODE |
| F037350 | Other | MI | WEB DENIS IDENTIFIER |
| 187925000 | Other | MI | MAGELLAN IDENTIFIER |
| 0910921 | Other | MI | BCBS OF MICHIGAN |
| 125750 | Other | MI | VALUE OPTIONS PROVIDER ID |
| P69427 | Other | MI | BLUE CARE NETWORK PIN |
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