Healthcare Provider Details

I. General information

NPI: 1538360615
Provider Name (Legal Business Name): KYRA STOVALL LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35200 LITTLE MACK AVE
CLINTON TOWNSHIP MI
48035-2634
US

IV. Provider business mailing address

1 FORD PL STE 3A
DETROIT MI
48202-3450
US

V. Phone/Fax

Practice location:
  • Phone: 586-790-4096
  • Fax:
Mailing address:
  • Phone: 313-874-4806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401008142
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: