Healthcare Provider Details

I. General information

NPI: 1649393125
Provider Name (Legal Business Name): ALLYN ALEVE MARIE CUEVAS OJEDA M.S., L.L.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13101 ALLEN RD STE. 100
SOUTHGATE MI
48195-2216
US

IV. Provider business mailing address

9754 SAWGRASS CT
BELLEVILLE MI
48111-6428
US

V. Phone/Fax

Practice location:
  • Phone: 734-785-7701
  • Fax:
Mailing address:
  • Phone: 734-785-7705
  • Fax: 734-785-7731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301008169
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: