Healthcare Provider Details

I. General information

NPI: 1568492411
Provider Name (Legal Business Name): NATALIE BROHL PERELLI PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6223 N CANTON CENTER RD SUITE 210
CANTON MI
48187-2696
US

IV. Provider business mailing address

45227 PINETREE DR
PLYMOUTH MI
48170-3842
US

V. Phone/Fax

Practice location:
  • Phone: 734-737-1200
  • Fax:
Mailing address:
  • Phone: 734-451-7487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301012759
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: