Healthcare Provider Details

I. General information

NPI: 1720001845
Provider Name (Legal Business Name): DEVON ELIZABETH BATTERSHELL MA, LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 11/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 ANDOVER RD STE 150-W
BLOOMFIELD TOWNSHIP MI
48302-1909
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 Code103TC0700X
TaxonomyClinical Psychologist
License Number6301012082
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: