Healthcare Provider Details

I. General information

NPI: 1275047342
Provider Name (Legal Business Name): MICHELE LYNN SELOVER MA LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5958 N CANTON CENTER RD
CANTON MI
48187-2765
US

IV. Provider business mailing address

30011 GLADYS AVE
WESTLAND MI
48185-1714
US

V. Phone/Fax

Practice location:
  • Phone: 734-737-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6361006413
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: