Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 6301011568 | MI |
NPI | 1144415522 |
---|---|
Provider Name | Mr. Brian Majerczyk |
First Address | Traverse City, MI 49684-3247 |
Second Address | Traverse City, MI 49684-3247 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2007 |
Last Update Date | 10/09/2007 |