MEDICARE: FARMINGTON HILLS CENTER FOR CHILD THERAPY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1023715141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARMINGTON HILLS CENTER FOR CHILD THERAPY PLLC

Provider Business Mailing Address
First Line	:	32813 MIDDLEBELT RD STE L
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-1702
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	32813 MIDDLEBELT RD STE L
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-1702
Country	:	US
Telephone Number	:	248-626-0478
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MORGAN HADDEN
Credential	:
Telephone Number	:	248-626-0478

Provider Enumeration Date	:	02/09/2023
Last Update Date	:	02/09/2023

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