Healthcare Provider Details

I. General information

NPI: 1548665045
Provider Name (Legal Business Name): PUJA SHROFF THORIA MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PUJA S SHROFF MS

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARKLANE BLVD STE 1200E
DEARBORN MI
48126
US

IV. Provider business mailing address

3795 PALISADES BLVD
YPSILANTI MI
48197-7502
US

V. Phone/Fax

Practice location:
  • Phone: 800-693-1916
  • Fax:
Mailing address:
  • Phone: 724-208-6421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401016570
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC007530
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401016570
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: