Healthcare Provider Details

I. General information

NPI: 1396059473
Provider Name (Legal Business Name): ALI MICHELLE KAPLAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17117 W 9 MILE RD
SOUTHFIELD MI
48075-4602
US

IV. Provider business mailing address

3035 N ALTADENA AVE
ROYAL OAK MI
48073-3555
US

V. Phone/Fax

Practice location:
  • Phone: 248-483-7804
  • Fax:
Mailing address:
  • Phone: 859-494-3222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301014264
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: