Organization
LAKESHORE PSYCHOLOGICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN A RYAN PH.D. (OWNER)
(586) 777-0470
Entity
Organization
Contact information
Practice address
22811 GREATER MACK AVE, SUITE L-3, SAINT CLAIR SHORES, MI 48080-2021
(586) 777-0470
Mailing address
22811 GREATER MACK AVE, SUITE L-3, SAINT CLAIR SHORES, MI 48080-2021
(586) 777-0470
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6301002572
MI
Other
Enumeration date
12/13/2006
Last updated
08/22/2020
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