Organization Name: | MUNSON HEALTHCARE GRAYLING |
NPI Number: | 1598131617 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARK A HEPLER (CFO) |
Mailing Address: | 234 Lake St Roscommon |
State: | MI US |
Postal Code: | 486539203 |
Phone Number: | 9892751200 |
Fax Number: | |
NPI Enumeration Date: | 08/12/2015 |
NPI Last Update Date: | 11/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |