Healthcare Provider Details

I. General information

NPI: 1427229095
Provider Name (Legal Business Name): UNIVERSITY OF MICHIGAN PSYCHOLOGICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 07/25/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S 5TH AVE
ANN ARBOR MI
48104
US

IV. Provider business mailing address

210 S 5TH AVE
ANN ARBOR MI
48104
US

V. Phone/Fax

Practice location:
  • Phone: 734-615-7853
  • Fax: 734-764-8128
Mailing address:
  • Phone: 734-615-7853
  • Fax: 734-764-8128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MEAGJAN FESLER
Title or Position: CLINIC AND OPERATIONS MANAGER
Credential: M.S. , LLP
Phone: 734-764-2961