Healthcare Provider Details

I. General information

NPI: 1043590896
Provider Name (Legal Business Name): REBECCA HATTON, PSYD, LICENSED PSYCHOLOGIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E WASHINGTON ST SUITE 400B
ANN ARBOR MI
48104-2017
US

IV. Provider business mailing address

2035 SUFFOLK ST
ANN ARBOR MI
48103-5049
US

V. Phone/Fax

Practice location:
  • Phone: 734-709-2183
  • Fax:
Mailing address:
  • Phone: 734-709-2183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number6301012318
License Number StateMI

VIII. Authorized Official

Name: DR. REBECCA HATTON
Title or Position: LICENSED PSYCHOLOGIST
Credential: PSYD, LP
Phone: 734-709-2183