Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | L438946 | MI |
NPI | 1457759094 |
---|---|
Provider Name | Mr. Jonathan Forgiel |
First Address | Monroe, MI 48161-9545 |
Second Address | Monroe, MI 48161-9545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2014 |
Last Update Date | 15/12/2014 |