Healthcare Provider Details

I. General information

NPI: 1104791722
Provider Name (Legal Business Name): SERENA LYNN HULIHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23800 NORTHWESTERN HWY STE 190L
SOUTHFIELD MI
48075-7740
US

IV. Provider business mailing address

30205 UTICA RD APT 111
ROSEVILLE MI
48066-1523
US

V. Phone/Fax

Practice location:
  • Phone: 231-412-9278
  • Fax:
Mailing address:
  • Phone: 586-248-1895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: