Healthcare Provider Details

I. General information

NPI: 1437620978
Provider Name (Legal Business Name): CHRISTOPHER YOO MA, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28303 JOY RD
WESTLAND MI
48185-5524
US

IV. Provider business mailing address

14629 NEWBURGH RD
LIVONIA MI
48154-5015
US

V. Phone/Fax

Practice location:
  • Phone: 734-752-4126
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401019020
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401016944
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401019020
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: