Healthcare Provider Details

I. General information

NPI: 1013200922
Provider Name (Legal Business Name): CHERIE BEBA MA, LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 DIVERSION ST SUITE 150
ROCHESTER HILLS MI
48307-2267
US

IV. Provider business mailing address

40523 DENBIGH DR
STERLING HEIGHTS MI
48310-6943
US

V. Phone/Fax

Practice location:
  • Phone: 586-872-3908
  • Fax:
Mailing address:
  • Phone: 586-872-3908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301013227
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: