Healthcare Provider Details

I. General information

NPI: 1811801491
Provider Name (Legal Business Name): LILACH BARAK TLLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 W BIG BEAVER RD STE 520
TROY MI
48084-3442
US

IV. Provider business mailing address

5895 KINGSFIELD DR
WEST BLOOMFIELD MI
48322-1479
US

V. Phone/Fax

Practice location:
  • Phone: 248-646-6659
  • Fax:
Mailing address:
  • Phone: 248-590-1470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6362010388
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: