Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 6301002516 | MI |
N | 103TC0700X | Clinical Psychologist | 6301002516 | MI |
N | 102L00000X | Psychologist | 6301002516 | MI |
N | 103T00000X | Psychologist | 6301002516 | MI |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 6301002516 | MI |
Y | 103G00000X | Clinical Psychologist | 6301002516 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301002516 | MI |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 6301002516 | MI |
N | 103TF0200X | Forensic Psychologist | 6301002516 | MI |
NPI | 1235221185 |
---|---|
Provider Name | Dr. Kenneth M Adams |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48105-2969 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 26/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S43101 | (02) | MI |