Healthcare Provider Details

I. General information

NPI: 1326921453
Provider Name (Legal Business Name): CATHERINE MONICA CHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8765 LEWIS AVE
TEMPERANCE MI
48182-9300
US

IV. Provider business mailing address

8765 LEWIS AVE
TEMPERANCE MI
48182-9300
US

V. Phone/Fax

Practice location:
  • Phone: 734-847-3802
  • Fax: 734-850-0520
Mailing address:
  • Phone: 734-847-3802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: