MEDICARE: MR. MICHAEL ANTHONY DEMOTT MA, LPC

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	101YM0800X	Mental Health Counselor	6401010517	MI

General Provider Information

NPI Number	:	1093726903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL ANTHONY DEMOTT MA, LPC

Provider Business Mailing Address
First Line	:	8623 N WAYNE RD
Second Line	:	SUITE 123
City	:	WESTLAND
State	:	MI
Zip	:	48185-1137
Country	:	US
Telephone Number	:	734-367-0469
Fax Number	:

Provider Business Practice Location Address
First Line	:	8623 N WAYNE RD
Second Line	:	SUITE 123
City	:	WESTLAND
State	:	MI
Zip	:	48185-1137
Country	:	US
Telephone Number	:	734-367-0469
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	04/08/2016

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