Organization
MCLAREN BAY REGION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIELLE C JACKS PORTER (CFO)
(989) 894-3838
Entity
Organization
Contact information
Practice address
690 S TRUMBULL ST, BAY CITY, MI 48708
(989) 922-4900
(989) 922-4911
Mailing address
690 S TRUMBULL ST, BAY CITY, MI 48708-7692
(989) 922-4900
(989) 922-4911
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
4703086129
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
470386129
STATE LICENSE
MI
Enumeration date
03/04/2014
Last updated
08/09/2018
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