Provider Demographics
NPI:1154998953
Name:INNOVATIVE PSYCHOLOGICAL SERVICES AND ASSESSMENTS PLLC
Entity type:Organization
Organization Name:INNOVATIVE PSYCHOLOGICAL SERVICES AND ASSESSMENTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-732-7861
Mailing Address - Street 1:1258 HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1363
Mailing Address - Country:US
Mailing Address - Phone:313-732-7861
Mailing Address - Fax:
Practice Address - Street 1:1258 HAMPTON RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1363
Practice Address - Country:US
Practice Address - Phone:313-732-7861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-09
Last Update Date:2023-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health