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1651 W Centre Ave Portage MI 49024-6312 | |
| (269) 552-9832 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 1651 W Centre Ave, Portage, Michigan |
| Authorized Official Name and Position | Jayne Fabry (OWNER) |
| Authorized Official Contact | 2695529832 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1651 W Centre Ave Portage MI 49024-6312 Ph: (269) 552-9832 | 1651 W Centre Ave Portage MI 49024-6312 Ph: (269) 552-9832 |
| NPI Number | 1952597767 |
|---|---|
| Provider Enumeration Date | 09/15/2007 |
| Last Update Date | 08/12/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952597767 | NPI | - | NPPES |
| 0C913440 | Other | MI | BCBSM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 6301008864 (Michigan) | Primary |
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