| Grand Traverse Assessment And Therapy, Pllc | |
|
5123 N Royal Dr Traverse City MI 49684-9201 | |
| (517) 887-9801 | |
| Not Available |
| Full Name | Grand Traverse Assessment And Therapy, Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 5123 N Royal Dr, Traverse City, Michigan |
| Authorized Official Name and Position | Robert Fabiano (CO-MANAGER) |
| Authorized Official Contact | 5172437027 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Traverse Assessment And Therapy, Pllc 5123 N Royal Dr Traverse City MI 49684-9201 Ph: () - | Grand Traverse Assessment And Therapy, Pllc 5123 N Royal Dr Traverse City MI 49684-9201 Ph: (517) 887-9801 |
| NPI Number | 1912480518 |
|---|---|
| Provider Enumeration Date | 09/10/2018 |
| Last Update Date | 01/28/2019 |
| Medicare PECOS PAC ID | 9638411226 |
|---|---|
| Medicare Enrollment ID | O20190501000865 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912480518 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Robert J Fabiano |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1629157185 PECOS PAC ID: 1759277569 Enrollment ID: I20041013000443 |
| Provider Name | Alfred Mansour |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1275876963 PECOS PAC ID: 1254636616 Enrollment ID: I20160223000373 |
| Provider Name | Glen Lee Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1992758353 PECOS PAC ID: 3274875869 Enrollment ID: I20190501000931 |
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