Healthcare Provider Details

I. General information

NPI: 1275793697
Provider Name (Legal Business Name): THERESA ANN HABIB M.S., L.L.P.,C.B.I.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26729 W CARNEGIE PARK DR
SOUTHFIELD MI
48034-6165
US

IV. Provider business mailing address

26729 W CARNEGIE PARK DR
SOUTHFIELD MI
48034-6165
US

V. Phone/Fax

Practice location:
  • Phone: 248-417-7674
  • Fax: 248-354-7477
Mailing address:
  • Phone: 248-417-7674
  • Fax: 248-354-7477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6301008272
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: