Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 4101006164 | MI |
NPI | 1114955887 |
---|---|
Provider Name | Patricia Danks |
First Address | Taylor, MI 48180-1846 |
Second Address | Taylor, MI 48180-1846 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4101006164 | LICENSE (01) | MI |