Healthcare Provider Details

I. General information

NPI: 1619415619
Provider Name (Legal Business Name): LINDA OHL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5086 ABINGDON CIR
ANN ARBOR MI
48108-5930
US

IV. Provider business mailing address

5086 ABINGDON CIR
ANN ARBOR MI
48108-5930
US

V. Phone/Fax

Practice location:
  • Phone: 734-223-0459
  • Fax:
Mailing address:
  • Phone: 734-223-0459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801083799
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: