| Limited License Psychology | |
|
2799 W Grand Blvd Detroit MI 48202-2608 | |
| (313) 916-2600 | |
| Not Available |
| Full Name | Limited License Psychology |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 2799 W Grand Blvd, Detroit, Michigan |
| Authorized Official Name and Position | Jodie Roberts (MANAGER) |
| Authorized Official Contact | 2486414041 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Limited License Psychology 1 Ford Pl Ste 2e Detroit MI 48202-3450 Ph: (313) 874-4316 | Limited License Psychology 2799 W Grand Blvd Detroit MI 48202-2608 Ph: (313) 916-2600 |
| NPI Number | 1073040093 |
|---|---|
| Provider Enumeration Date | 05/22/2017 |
| Last Update Date | 08/23/2024 |
| Certification Date | 08/23/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073040093 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (Michigan) | Primary |
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