Healthcare Provider Details

I. General information

NPI: 1558800631
Provider Name (Legal Business Name): LYN SPENCE MA, LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44070 W 12 MILE RD SUITE 200
NOVI MI
48377-2648
US

IV. Provider business mailing address

44070 W 12 MILE RD SUITE 200
NOVI MI
48377-2648
US

V. Phone/Fax

Practice location:
  • Phone: 248-773-8440
  • Fax: 248-773-8441
Mailing address:
  • Phone: 248-773-8440
  • Fax: 248-773-8441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401015233
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: