Healthcare Provider Details

I. General information

NPI: 1295668838
Provider Name (Legal Business Name): ERIC AJLUNI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CROOKS RD STE 100
TROY MI
48084-4733
US

IV. Provider business mailing address

30470 LEEMOOR ST
BEVERLY HILLS MI
48025-4915
US

V. Phone/Fax

Practice location:
  • Phone: 247-731-7305
  • Fax:
Mailing address:
  • Phone: 248-513-2747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6352001180
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: