Provider Demographics
NPI:1265734644
Name:REBECCA MAIR P C
Entity type:Organization
Organization Name:REBECCA MAIR P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MAIR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:313-821-0098
Mailing Address - Street 1:15450 E JEFFERSON AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-2033
Mailing Address - Country:US
Mailing Address - Phone:313-821-0098
Mailing Address - Fax:313-884-9758
Practice Address - Street 1:15450 E JEFFERSON AVE STE 140
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-2033
Practice Address - Country:US
Practice Address - Phone:313-821-0098
Practice Address - Fax:313-884-9758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008126103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0894458Medicare PIN