Healthcare Provider Details

I. General information

NPI: 1811904931
Provider Name (Legal Business Name): M. JANICE GUTFREUND, PH.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 08/22/2020
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

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

V. Phone/Fax

Practice location:
  • Phone: 734-213-1075
  • Fax: 734-213-1075
Mailing address:
  • Phone: 734-213-1075
  • Fax: 734-213-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MARY JANICE GUTFREUND
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 734-213-1075