MEDICARE: NADIA SELAMEH 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	101YP2500X	Professional Counselor	6401013638	MI

General Provider Information

NPI Number	:	1134789670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADIA SELAMEH LPC

Provider Business Mailing Address
First Line	:	1061 INKSTER RD
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-3168
Country	:	US
Telephone Number	:	313-307-0088
Fax Number	:	313-281-2235

Provider Business Practice Location Address
First Line	:	1061 INKSTER RD
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-3168
Country	:	US
Telephone Number	:	313-307-0088
Fax Number	:	313-281-2235

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

Provider Enumeration Date	:	06/17/2019
Last Update Date	:	06/17/2019

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