Healthcare Provider Details

I. General information

NPI: 1588512958
Provider Name (Legal Business Name): CLAIRE NUSSDORFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 HOGSBACK RD STE C
MASON MI
48854-8525
US

IV. Provider business mailing address

4519 HIGHLAND RD STE 300
WATERFORD MI
48328-1132
US

V. Phone/Fax

Practice location:
  • Phone: 517-969-4029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4151001161
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: