Healthcare Provider Details

I. General information

NPI: 1649960832
Provider Name (Legal Business Name): MAURICEMARIA UMEJIEGO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5777 W MAPLE RD STE 100
WEST BLOOMFIELD MI
48322-2268
US

IV. Provider business mailing address

2900 WELCH RD
COMMERCE TOWNSHIP MI
48390-1562
US

V. Phone/Fax

Practice location:
  • Phone: 248-767-7927
  • Fax:
Mailing address:
  • Phone: 517-249-4209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6362010475
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: