Organization
GREAT LAKES PSYCHOLOGICAL ASSOCIATES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEREMY ADAM MOEGGENBERG PSYD (OWNER)
(989) 317-3188
Entity
Organization
Contact information
Practice address
400 S UNIVERSITY AVE, MT PLEASANT, MI 48858-3170
(989) 317-3188
(989) 202-1888
Mailing address
400 S UNIVERSITY AVE, MT PLEASANT, MI 48858-3170
(989) 317-3188
(989) 202-1888
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301014926
MI
Other
Enumeration date
09/15/2015
Last updated
01/04/2019
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