Healthcare Provider Details

I. General information

NPI: 1386754117
Provider Name (Legal Business Name): GERDA T MAH MA LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 W BIG BEAVER RD 1450
TROY MI
48084-4736
US

IV. Provider business mailing address

2958 ORBIT DR
LAKE ORION MI
48360-1976
US

V. Phone/Fax

Practice location:
  • Phone: 248-244-8644
  • Fax: 248-244-1330
Mailing address:
  • Phone: 248-391-2043
  • Fax: 248-391-0890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301000810
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: