Healthcare Provider Details

I. General information

NPI: 1457900128
Provider Name (Legal Business Name): ALEXIS NIKOL ALMUTHAFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 GRISWOLD ST STE 100
NORTHVILLE MI
48167-2687
US

IV. Provider business mailing address

835 MASON ST STE A135
DEARBORN MI
48124-2231
US

V. Phone/Fax

Practice location:
  • Phone: 734-325-8685
  • Fax:
Mailing address:
  • Phone: 734-288-7977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361008205
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: