Provider Demographics
NPI:1427229095
Name:UNIVERSITY OF MICHIGAN PSYCHOLOGICAL CLINIC
Entity type:Organization
Organization Name:UNIVERSITY OF MICHIGAN PSYCHOLOGICAL CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC AND OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEAGJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FESLER
Authorized Official - Suffix:
Authorized Official - Credentials:MS , LLP
Authorized Official - Phone:734-764-2961
Mailing Address - Street 1:210 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104
Mailing Address - Country:US
Mailing Address - Phone:734-615-7853
Mailing Address - Fax:734-764-8128
Practice Address - Street 1:210 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104
Practice Address - Country:US
Practice Address - Phone:734-615-7853
Practice Address - Fax:734-764-8128
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGENTS OF THE UNIVERSITY OF MICHIGAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-21
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1518065986OtherNPPES