Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 6301006873 | MI |
NPI | 1215058425 |
---|---|
Provider Name | Mr. James Mark Slater |
First Address | Lansing, MI 48912-4802 |
Second Address | Howell, MI 48843-8548 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/07/2007 |