| Organization Name: | MIDWEST MICHIGAN PSYCHOLOGICAL ASSOCIATES, PLLC |
| NPI Number: | 1033318340 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CRAIG ALLEN DERROR (EXECUTIVE DIRECTOR) |
| Mailing Address: | 811 Sunnyside Dr Suite I Cadillac |
| State: | MI US |
| Postal Code: | 496017002 |
| Phone Number: | 2318783059 |
| Fax Number: | 8662171182 |
| NPI Enumeration Date: | 07/16/2007 |
| NPI Last Update Date: | 07/16/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 6401004326 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |