Healthcare Provider Details

I. General information

NPI: 1619533569
Provider Name (Legal Business Name): JAYLEN GAVIE LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42804 GARFIELD RD
CLINTON TWP MI
48038-1656
US

IV. Provider business mailing address

42804 GARFIELD RD
CLINTON TWP MI
48038-1656
US

V. Phone/Fax

Practice location:
  • Phone: 586-323-2957
  • Fax:
Mailing address:
  • Phone: 586-323-2957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361007808
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: