Healthcare Provider Details

I. General information

NPI: 1548720469
Provider Name (Legal Business Name): ALOE INTEGRATIVE PSYCHOLOGY GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 WALTON BLVD STE 205
ROCHESTER HILLS MI
48309-1484
US

IV. Provider business mailing address

2490 WALTON BLVD STE 205
ROCHESTER HILLS MI
48309-1484
US

V. Phone/Fax

Practice location:
  • Phone: 248-218-0622
  • Fax: 248-218-0612
Mailing address:
  • Phone: 248-218-0622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NICOLE MARIE-BUDRY LAW
Title or Position: OWNER
Credential: PSYD, LP
Phone: 248-218-0588