Healthcare Provider Details

I. General information

NPI: 1285529016
Provider Name (Legal Business Name): CAITLIN MAHONEY TLLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 PLYMOUTH RD STE 250
PLYMOUTH MI
48170-1842
US

IV. Provider business mailing address

409 PLYMOUTH RD STE 250
PLYMOUTH MI
48170-1842
US

V. Phone/Fax

Practice location:
  • Phone: 734-416-9098
  • Fax:
Mailing address:
  • Phone: 734-416-9098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301012563
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: