Healthcare Provider Details

I. General information

NPI: 1891633186
Provider Name (Legal Business Name): LARA SALEH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3002 CARPENTER ST
HAMTRAMCK MI
48212-2768
US

IV. Provider business mailing address

4087 OLIVER ST
DETROIT MI
48211-1593
US

V. Phone/Fax

Practice location:
  • Phone: 313-288-9793
  • Fax: 313-447-2709
Mailing address:
  • Phone: 313-960-2186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: