Provider Demographics
NPI:1023429438
Name:FAMILY PSYCHOLOGICAL SERVICES, PLLC
Entity type:Organization
Organization Name:FAMILY PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:231-838-8560
Mailing Address - Street 1:321 E LAKE ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2478
Mailing Address - Country:US
Mailing Address - Phone:231-838-8560
Mailing Address - Fax:231-344-6003
Practice Address - Street 1:321 E LAKE ST
Practice Address - Street 2:SUITE 7
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2478
Practice Address - Country:US
Practice Address - Phone:231-838-8560
Practice Address - Fax:231-344-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-20
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty