Healthcare Provider Details

I. General information

NPI: 1578816245
Provider Name (Legal Business Name): AARON MICHAEL REINA M.S., L.L.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 S MAIN ST
PLYMOUTH MI
48170-2217
US

IV. Provider business mailing address

3410 RIDGEVIEW DR
CLYDE MI
48049-4318
US

V. Phone/Fax

Practice location:
  • Phone: 734-451-3440
  • Fax:
Mailing address:
  • Phone: 313-680-4614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301015331
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301015331
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361006597
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: