MEDICARE: MRS. CORA MARIE GARTH L.L.P.C.

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	6401013171	MI

General Provider Information

NPI Number	:	1164896833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CORA MARIE GARTH L.L.P.C.

Provider Business Mailing Address
First Line	:	27460 PIERCE ST
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-7409
Country	:	US
Telephone Number	:	313-801-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 W LONG LAKE RD
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48098-4313
Country	:	US
Telephone Number	:	313-801-2222
Fax Number	:

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

Provider Enumeration Date	:	11/18/2015
Last Update Date	:	11/18/2015

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Directions to “ MRS. CORA MARIE GARTH L.L.P.C.” Practice Location

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