Healthcare Provider Details
I. General information
NPI: 1952326837
Provider Name (Legal Business Name): UNIVERSITY OF MICHIGAN-UNIVERSITY CENTER FOR THE CHILD AND FAMILY
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/13/2006
Last Update Date: 07/25/2024
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
210 5TH AVE
ANN ARBOR MI
48104
US
IV. Provider business mailing address
210 5TH AVE
ANN ARBOR MI
48104
US
V. Phone/Fax
- Phone: 734-615-7853
- Fax:
- Phone: 734-615-7853
- Fax: 734-764-8128
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103TC2200X |
| Taxonomy | Clinical Child & Adolescent Psychologist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
MEAGHAN
FESLER
Title or Position: CLINIC AND OPERATIONS MANAGER
Credential: M.S., LLP
Phone: 734-764-2961