Healthcare Provider Details

I. General information

NPI: 1225285331
Provider Name (Legal Business Name): MICHELLE H KLINGER LMW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31700 W 13 MILE RD SUITE 219
FARMINGTON HILLS MI
48334-2166
US

IV. Provider business mailing address

30445 W 14 MILE RD APT 70
FARMINGTON HILLS MI
48334-1549
US

V. Phone/Fax

Practice location:
  • Phone: 248-210-0523
  • Fax:
Mailing address:
  • Phone: 248-210-0523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number6801078103
License Number StateMI

VIII. Authorized Official

Name: MS. MICHELLE H KLINGER
Title or Position: PSYCHOTHERAPIST
Credential: LMSW
Phone: 248-210-0523