Healthcare Provider Details

I. General information

NPI: 1497116164
Provider Name (Legal Business Name): ROBERT EDWIN COMPTON M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2016
Last Update Date: 03/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 TEMPLE ST 8TH FLOOR
DETROIT MI
48201-2599
US

IV. Provider business mailing address

20789 CAMDEN SQ # 203
SOUTHFIELD MI
48076
US

V. Phone/Fax

Practice location:
  • Phone: 313-344-9099
  • Fax: 313-833-2155
Mailing address:
  • Phone: 313-408-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301009083
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301009083
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301009083
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number6301009083
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: