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Organization

JAYNE FABRY, PTC ASSOCIATES

Active
Other names
Professional Therapy Consultation
Organization subpart
No

Provider details

NPI number
Authorized official
JAYNE FABRY CLINICAL PSYCHOLOGIS (OWNER)
(269) 552-9832
Entity
Organization

Contact information

Practice address
1651 W CENTRE AVE, PORTAGE, MI 49024-6312
(269) 552-9832
Mailing address
1651 W CENTRE AVE, PORTAGE, MI 49024-6312
(269) 552-9832

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301008864
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0C913440
BCBSM
MI
Enumeration date
09/15/2007
Last updated
08/12/2008
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