Healthcare Provider Details

I. General information

NPI: 1679496574
Provider Name (Legal Business Name): ALEXIS ANN MISANY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8072 21 MILE RD
SHELBY TOWNSHIP MI
48317-4310
US

IV. Provider business mailing address

29066 BAY POINTE DR
CHESTERFIELD MI
48047-6016
US

V. Phone/Fax

Practice location:
  • Phone: 586-932-2700
  • Fax:
Mailing address:
  • Phone: 586-850-1757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6362010036
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: