Healthcare Provider Details

I. General information

NPI: 1174156822
Provider Name (Legal Business Name): AMYNA FTOUNI PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 04/11/2020
Certification Date: 04/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

553 E JEFFERSON AVE
DETROIT MI
48226-4324
US

IV. Provider business mailing address

5643 DACOSTA ST
DEARBORN HEIGHTS MI
48127-2415
US

V. Phone/Fax

Practice location:
  • Phone: 313-992-7951
  • Fax:
Mailing address:
  • Phone: 313-909-4099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State

VIII. Authorized Official

Name: AMYNA FTOUNI
Title or Position: OWNER
Credential:
Phone: 313-909-4099