Healthcare Provider Details

I. General information

NPI: 1003094178
Provider Name (Legal Business Name): MARY K ANDERSON PHD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N 1ST ST STE 1
ANN ARBOR MI
48104-1397
US

IV. Provider business mailing address

111 N 1ST ST STE 1
ANN ARBOR MI
48104-1397
US

V. Phone/Fax

Practice location:
  • Phone: 734-327-5934
  • Fax:
Mailing address:
  • Phone: 734-327-5934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number6301008873
License Number StateMI

VIII. Authorized Official

Name: MARY KATHRYN ANDERSON
Title or Position: PSYCHOLOGIST/MANAGER
Credential: PHD
Phone: 734-327-5934