Provider Demographics
NPI:1104806850
Name:PAURITSCH, ANDRE' (PHD, LLP)
Entity type:Individual
Prefix:
First Name:ANDRE'
Middle Name:
Last Name:PAURITSCH
Suffix:
Gender:M
Credentials:PHD, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 WALTON BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1779
Mailing Address - Country:US
Mailing Address - Phone:586-303-7785
Mailing Address - Fax:586-580-2329
Practice Address - Street 1:1460 WALTON BLVD STE 203
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1779
Practice Address - Country:US
Practice Address - Phone:586-303-7785
Practice Address - Fax:586-580-2329
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012477103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent