Healthcare Provider Details

I. General information

NPI: 1598778375
Provider Name (Legal Business Name): MARY JO BELONGEA MA,LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY JO BELONGEA MA,LLP

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657 WATERSEDGE DR
ANN ARBOR MI
48105-2514
US

IV. Provider business mailing address

657 WATERSEDGE DR
ANN ARBOR MI
48105-2514
US

V. Phone/Fax

Practice location:
  • Phone: 734-417-8438
  • Fax:
Mailing address:
  • Phone: 734-417-8438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6301010255
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301010255
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: