Healthcare Provider Details

I. General information

NPI: 1396885810
Provider Name (Legal Business Name): JENNIFER ANN FELIX L.L.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 STEPHENSON HWY STE 200
TROY MI
48083-1132
US

IV. Provider business mailing address

1510 MOHAWK AVE
ROYAL OAK MI
48067-3334
US

V. Phone/Fax

Practice location:
  • Phone: 248-585-3239
  • Fax:
Mailing address:
  • Phone: 586-822-0061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301013165
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: