Provider Demographics
NPI:1316156698
Name:PSYCHOPHARMACOLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:PSYCHOPHARMACOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PSYCHIATRY
Authorized Official - Prefix:DR
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:V
Authorized Official - Last Name:KEVONIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD PLC
Authorized Official - Phone:248-539-0200
Mailing Address - Street 1:28800 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2981
Mailing Address - Country:US
Mailing Address - Phone:248-539-0200
Mailing Address - Fax:
Practice Address - Street 1:28800 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2981
Practice Address - Country:US
Practice Address - Phone:248-539-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI051500103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF46965Medicare UPIN