Healthcare Provider Details

I. General information

NPI: 1003721382
Provider Name (Legal Business Name): TRACY ANNE OLAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 FOREST AVE
PLYMOUTH MI
48170-1775
US

IV. Provider business mailing address

14436 RIVERSIDE ST
LIVONIA MI
48154-5300
US

V. Phone/Fax

Practice location:
  • Phone: 734-446-5466
  • Fax:
Mailing address:
  • Phone: 734-751-0789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6362010391
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: