Provider Demographics
NPI:1962807644
Name:CLINICAL PSYCHOLOGY SERVICES, PLLC
Entity type:Organization
Organization Name:CLINICAL PSYCHOLOGY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:O
Authorized Official - Last Name:AJAYI-NABORS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:269-206-1480
Mailing Address - Street 1:350 E MICHIGAN AVE
Mailing Address - Street 2:SUITE 135
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3800
Mailing Address - Country:US
Mailing Address - Phone:269-206-1480
Mailing Address - Fax:269-366-4946
Practice Address - Street 1:350 E MICHIGAN AVE
Practice Address - Street 2:SUITE 135
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3800
Practice Address - Country:US
Practice Address - Phone:269-206-1480
Practice Address - Fax:269-366-4946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health