Healthcare Provider Details

I. General information

NPI: 1487268538
Provider Name (Legal Business Name): DEVON BATTERSHELL MA LLP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2020
Last Update Date: 09/06/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39520 WOODWARD AVE STE 201
BLOOMFIELD HILLS MI
48304-5057
US

IV. Provider business mailing address

9557 TRACE HOLLOW CT
COMMERCE TWP MI
48382-3672
US

V. Phone/Fax

Practice location:
  • Phone: 248-635-6637
  • Fax:
Mailing address:
  • Phone: 248-635-6637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEVON ELIZABETH BATTERSHELL
Title or Position: OWNER
Credential: MA LLP
Phone: 248-635-6637