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South Mi Psychiatric Services Llc
Prescribing (Medical) Psychologist in Portage, Michigan
NPI 1932635521

South Mi Psychiatric Services Llc is a Prescribing (Medical) Psychologist based in Portage, MI and is specialized in Prescribing (Medical). South Mi Psychiatric Services Llc practices in Portage, MI. The NPI Number for South Mi Psychiatric Services Llc is 1932635521 and holds a License No. 4301078095 (Michigan).

The current practice location address for South Mi Psychiatric Services Llc is 5930 Lovers Ln Ste 3, Portage, MI and can be reached out via phone at 269-381-6950 and via fax at 269-381-6954.

Location: 5930 Lovers Ln Ste 3, Portage, MI, 49002-1673
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1932635521
Provider Name
South Mi Psychiatric Services Llc
Credential
Provider Entity Type
Organization
Address
5930 Lovers Ln Ste 3, Portage, MI, 49002-1673
Phone Number
269-381-6950
Fax Number
269-381-6954
Provider Enumeration Date
05/03/2017
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1932194214 01 MI NATIONAL IDENTIFICATION NUMBER
1598724122 01 MI NATIONAL IDENTIFICATION NUMBER
institution
Provider Business Practice Location Address Details
Address
5930 Lovers Ln Ste 3
City
Portage
State
Michigan
Zip
49002-1673
Phone Number
269-381-6950
Fax Number
269-381-6954
person
Provider Business Mailing Address Details
Address
5930 Lovers Ln Ste 3
City
Portage
State
Michigan
Zip
49002-1673
Phone Number
269-381-6950
Fax Number
269-381-6954
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Psychologist
Speciality
Prescribing (Medical)
Taxonomy
103TP0016X
License No.
4301078095 (Michigan)
Definition
A licensed, doctoral-level psychologist authorized to prescribe and has undergone specialized education and training in preparation for prescriptive practice and has passed an examination accepted by the state board of psychology relevant to establishing competence for prescribing, and has received from the state board of psychology a current certificate granting prescriptive authority, which has not been revoked or suspended.
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