Healthcare Provider Details

I. General information

NPI: 1639617426
Provider Name (Legal Business Name): CHELSEA BUZZITTA M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHELSEA KNEIP

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6548 TOWN CENTER DR SUITE D
CLARKSTON MI
48346-4823
US

IV. Provider business mailing address

6548 TOWN CENTER DR SUITE D
CLARKSTON MI
48346-4823
US

V. Phone/Fax

Practice location:
  • Phone: 800-693-1916
  • Fax:
Mailing address:
  • Phone: 800-693-1916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301018032
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301016892
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361000541
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: