Healthcare Provider Details

I. General information

NPI: 1952789877
Provider Name (Legal Business Name): ARBOR PSYCHOLOGY GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44450 PINETREE DR SUITE 101
PLYMOUTH MI
48170-3869
US

IV. Provider business mailing address

44450 PINETREE DR SUITE 101
PLYMOUTH MI
48170-3869
US

V. Phone/Fax

Practice location:
  • Phone: 734-738-0897
  • Fax: 734-738-0898
Mailing address:
  • Phone: 734-738-0897
  • Fax: 734-738-0898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301013977
License Number StateMI

VIII. Authorized Official

Name: DR. MICHAEL ANDREW BAMBERY
Title or Position: OWNER/DIRECTOR
Credential: PH.D.
Phone: 734-738-0897