Provider Demographics
NPI:1285953075
Name:SILLS, DAVID JEFFERY (DAVID SILLS, PSYS)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JEFFERY
Last Name:SILLS
Suffix:
Gender:M
Credentials:DAVID SILLS, PSYS
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:JEFFERY
Other - Last Name:SILLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DAVID SILLS
Mailing Address - Street 1:2100 W BIG BEAVER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3428
Mailing Address - Country:US
Mailing Address - Phone:248-709-0771
Mailing Address - Fax:
Practice Address - Street 1:2100 W BIG BEAVER RD
Practice Address - Street 2:SUITE 105
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3428
Practice Address - Country:US
Practice Address - Phone:248-709-0771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008933103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist