Healthcare Provider Details

I. General information

NPI: 1003554379
Provider Name (Legal Business Name): AMBER MICHON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16643 WHITBY ST
LIVONIA MI
48154-2508
US

IV. Provider business mailing address

16643 WHITBY ST
LIVONIA MI
48154-2508
US

V. Phone/Fax

Practice location:
  • Phone: 586-817-2432
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6352001226
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: