Healthcare Provider Details

I. General information

NPI: 1427569649
Provider Name (Legal Business Name): SARAH ELIZABETH BALOGH MA, LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2017
Last Update Date: 10/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 TELEGRAPH RD STE 200
TAYLOR MI
48180-3386
US

IV. Provider business mailing address

8782 BUCKSKIN DR
COMMERCE TOWNSHIP MI
48382-3402
US

V. Phone/Fax

Practice location:
  • Phone: 313-406-4493
  • Fax:
Mailing address:
  • Phone: 248-716-5501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401016053
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: