Healthcare Provider Details

I. General information

NPI: 1578114690
Provider Name (Legal Business Name): DR. STACIE COVELESKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39555 ORCHARD HILL PL STE 600
NOVI MI
48375-5381
US

IV. Provider business mailing address

290 VILLAGE GREEN BLVD APT 202
ANN ARBOR MI
48105-2790
US

V. Phone/Fax

Practice location:
  • Phone: 248-989-3005
  • Fax:
Mailing address:
  • Phone: 734-585-6387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0006402
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301019619
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: