Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 6301009001 | MI |
NPI | 1003086059 |
---|---|
Provider Name | Eileen M. Hathaway |
First Address | Mason, MI 48854-0010 |
Second Address | East Lansing, MI 48823-5034 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2008 |
Last Update Date | 05/09/2008 |