Healthcare Provider Details

I. General information

NPI: 1417337841
Provider Name (Legal Business Name): ANGELA PALAIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29812 DEER RUN
FARMINGTON HILLS MI
48331-1980
US

IV. Provider business mailing address

29812 DEER RUN
FARMINGTON HILLS MI
48331-1980
US

V. Phone/Fax

Practice location:
  • Phone: 808-727-9429
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number4101006705
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301016830
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: