Mr. Michael Eugene Wallace
Clinical Psychologist
201 E Liberty St Suite 2
Ann Arbor
, Michigan 48104-2118
Mr. Michael Eugene Wallace
Clinical Psychologist
201 E Liberty St Suite 2
Ann Arbor
, Michigan 48104-2118
(734) 330-3580
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About
Features
Specialties
- Clinical Psychologist
Languages spoken
- English
Location
First Address
- Mr. Michael Eugene Wallace
- 201 E. Liberty St. Suite 2
- Ann Arbor, MI
- Zip : 48104
- Phone : (734) 330-3580
Second Address
- Mr. Michael Eugene Wallace
- 201 E Liberty St Suite 2
- Ann Arbor, MI
- Zip : 48104-2118
- Phone : (734) 330-3580
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 103G00000X | Clinical Psychologist | 6301008847 | MI |
| Y | 103TC0700X | Clinical Psychologist | 6301008847 | MI |
National Provider Identifier
| NPI | 1003116658 |
|---|---|
| Provider Name | Mr. Michael Eugene Wallace |
| First Address | Ann Arbor, MI 48104 |
| Second Address | Ann Arbor, MI 48104-2118 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 29/10/2010 |
| Last Update Date | 29/10/2010 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.