Individual
PATCHAWAN PHUNWUTIKORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
1 GENESYS PKWY, GRAND BLANC, MI 48439-8065
(810) 606-5126
Mailing address
2004 FOX HILL DR APT 1, GRAND BLANC, MI 48439-5244
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8121
—
CA
Enumeration date
05/26/2017
Last updated
08/17/2022
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