Healthcare Provider Details

I. General information

NPI: 1063828051
Provider Name (Legal Business Name): JO-CHEN HOU MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 LONGFELLOW DR
TROY MI
48085-4881
US

IV. Provider business mailing address

830 LONGFELLOW DR
TROY MI
48085-4881
US

V. Phone/Fax

Practice location:
  • Phone: 734-931-6143
  • Fax:
Mailing address:
  • Phone: 734-931-6143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301015768
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: