# OLD TOWN PSYCHOLOGICAL SERVICES-GAYLORD

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** OLD TOWN PSYCHOLOGICAL SERVICES
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1750659249
- **Legal business name:** OLD TOWN PSYCHOLOGICAL SERVICES
- **Authorized official:** DR. MICHAEL P HAYES PH.D. (CEO)
- **Authorized official phone:** (989) 448-8344

## Contact information

- **Practice address:** 128 N COURT AVE, GAYLORD, MI 49735-1408
- **Practice address phone:** (989) 448-8344
- **Mailing address:** 512 S UNION ST, TRAVERSE CITY, MI 49684-3247
- **Mailing address phone:** (231) 941-6550
- **Mailing address fax:** (231) 941-8981

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | NULL | Yes |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | — | Yes |

## Other

- **Enumeration date:** 12/12/2011
- **Last updated:** 12/12/2011