Healthcare Provider Details

I. General information

NPI: 1487911020
Provider Name (Legal Business Name): LINDA THIBAULT PSYD LP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20793 FARMINGTON RD SUITE #17
FARMINGTON HILLS MI
48336-5182
US

IV. Provider business mailing address

20793 FARMINGTON RD STE 17
FARMINGTON HILLS MI
48336-5182
US

V. Phone/Fax

Practice location:
  • Phone: 734-657-8443
  • Fax:
Mailing address:
  • Phone: 734-657-8443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number6301014245
License Number StateMI

VIII. Authorized Official

Name: DR. LINDA THIBAULT
Title or Position: OWNER/PROPRIETOR
Credential: PSY.D.
Phone: 734-657-8443