Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 6301007920 | MI |
NPI | 1235241282 |
---|---|
Provider Name | Myra F. Alliston |
First Address | Burton, MI 48519-1455 |
Second Address | Grand Blanc, MI 48439-1812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 20/09/2007 |