=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043590896
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REBECCA HATTON, PSYD, LICENSED PSYCHOLOGIST
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2011
-----------------------------------------------------
Last Update Date | 02/15/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 202 E WASHINGTON ST SUITE 400B
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48104-2017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-709-2183
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2035 SUFFOLK ST
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48103-5049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-709-2183
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PSYCHOLOGIST
-----------------------------------------------------
Name | DR. REBECCA HATTON
-----------------------------------------------------
Credential | PSYD, LP
-----------------------------------------------------
Telephone | 734-709-2183
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number | 6301012318
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------