Healthcare Provider Details

I. General information

NPI: 1760980759
Provider Name (Legal Business Name): MIRIAM R MAY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 11/15/2020
Certification Date: 11/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 SUPERIOR ST
PORT HURON MI
48060-3748
US

IV. Provider business mailing address

100 NB GRATIOT AVE
MOUNT CLEMENS MI
48043-2301
US

V. Phone/Fax

Practice location:
  • Phone: 810-966-0099
  • Fax: 810-696-7339
Mailing address:
  • Phone: 586-783-2950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: