Healthcare Provider Details

I. General information

NPI: 1578085601
Provider Name (Legal Business Name): SEAN N HADDIX MA, LLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1385 IDA MAYBEE RD
MONROE MI
48162-9625
US

IV. Provider business mailing address

1385 IDA MAYBEE RD
MONROE MI
48162-9625
US

V. Phone/Fax

Practice location:
  • Phone: 734-652-4506
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6361008354
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: