Provider Demographics
NPI:1124476486
Name:BAY PSYCHOLOGICAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:BAY PSYCHOLOGICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIERAKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LLP
Authorized Official - Phone:989-686-1990
Mailing Address - Street 1:1420 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-6110
Mailing Address - Country:US
Mailing Address - Phone:989-686-1990
Mailing Address - Fax:989-686-0474
Practice Address - Street 1:1420 CENTER AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6110
Practice Address - Country:US
Practice Address - Phone:989-686-1990
Practice Address - Fax:989-686-0474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty