Healthcare Provider Details

I. General information

NPI: 1821900358
Provider Name (Legal Business Name): OLIVIA MOUNET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 S WALLACE BLVD
YPSILANTI MI
48197-4678
US

IV. Provider business mailing address

7087 HOMESTEAD RD
YPSILANTI MI
48197-6424
US

V. Phone/Fax

Practice location:
  • Phone: 734-263-1867
  • Fax:
Mailing address:
  • Phone: 734-263-1867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6352001124
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: