Organization
MICHIGAN MODERN PSYCHOLOGY GROUP,PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANUEL A MANRIQUE PHD (DIRECTOR)
(313) 561-9064
Entity
Organization
Contact information
Practice address
835 MASON ST, SUITE B 220, DEARBORN, MI 48124-2231
(313) 561-9064
(313) 563-4480
Mailing address
835 MASON ST, SUITE B 220, DEARBORN, MI 48124-2231
(313) 561-9064
(313) 563-4480
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
10/17/2016
Last updated
05/29/2024
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