Healthcare Provider Details

I. General information

NPI: 1417450719
Provider Name (Legal Business Name): MS. MICHELLE ELIZABETH THORPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 ASHFORD
ROCHESTER HLS MI
48306-3150
US

IV. Provider business mailing address

1126 LARIAT LOOP
ANN ARBOR MI
48108-2815
US

V. Phone/Fax

Practice location:
  • Phone: 248-410-5672
  • Fax:
Mailing address:
  • Phone: 248-410-5672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1801015723
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: