Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 6401009160 | MI |
N | 101YP2500X | Professional Counselor | 6401009160 | MI |
N | 102L00000X | Psychologist | 6301012786 | MI |
N | 103T00000X | Psychologist | 6301012786 | MI |
N | 103TC1900X | Counseling Psychologist | 6301012786 | MI |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 6301012786 | MI |
N | 103TF0000X | Family Psychologist | 6301012786 | MI |
NPI | 1124089099 |
---|---|
Provider Name | Mr. Joseph Richard Sanok |
First Address | Kalamazoo, MI 49048-3054 |
Second Address | Kalamazoo, MI 49009-2196 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2006 |
Last Update Date | 08/07/2007 |