Healthcare Provider Details

I. General information

NPI: 1639087083
Provider Name (Legal Business Name): ASYA BRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CORPORATE OFFICE DR STE 300
MILFORD MI
48381-5002
US

IV. Provider business mailing address

1100 CORPORATE OFFICE DR STE 300
MILFORD MI
48381-5002
US

V. Phone/Fax

Practice location:
  • Phone: 248-714-9289
  • Fax: 734-780-3005
Mailing address:
  • Phone: 248-714-9289
  • Fax: 734-780-3005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6362010410
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: