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NPI Code Detail

MEDICARE: MRS. CHRISTINA J. ISAACS L.L.P.

MEDICARE: MRS. CHRISTINA J. ISAACS L.L.P.
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
1103T00000XPsychologist6301009029MI
2103TC0700XClinical Psychologist6301009029MI
3103T00000XPsychologist6361004755MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
16361004755OTHERMILARA MICHIGAN LICENSE

General Provider Information

NPI Number : 1992869143
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CHRISTINA J. ISAACS L.L.P.
Provider Business Mailing Address
First Line : 1325 BEACHCOMBER BLVD
Second Line :
City : HARDEEVILLE
State : SC
Zip : 29927-4892
Country : US
Telephone Number : 248-961-4849
Fax Number :
Provider Business Practice Location Address
First Line : 13001 23 MILE RD
Second Line :
City : SHELBY TOWNSHIP
State : MI
Zip : 48315-2767
Country : US
Telephone Number : 248-961-4849
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2006
Last Update Date : 09/09/2022

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