Healthcare Provider Details

I. General information

NPI: 1316862600
Provider Name (Legal Business Name): CARLY LOSEY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2632 S MILFORD RD
HIGHLAND MI
48357-4938
US

IV. Provider business mailing address

2632 S MILFORD RD
HIGHLAND MI
48357-4938
US

V. Phone/Fax

Practice location:
  • Phone: 248-714-5194
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: