Healthcare Provider Details

I. General information

NPI: 1841129038
Provider Name (Legal Business Name): PHOENIX MIND PSYCHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 SOUTHERN ST
DEARBORN MI
48126-3721
US

IV. Provider business mailing address

30 BLAIR LN
DEARBORN MI
48120-1301
US

V. Phone/Fax

Practice location:
  • Phone: 313-242-7162
  • Fax:
Mailing address:
  • Phone: 313-573-3758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: ZEINA ANGELA YAHFOUFI
Title or Position: OWNER
Credential: LLP
Phone: 313-242-7162