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General NPI Number Information
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NPI Number | 1184079394
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Entity Type | Individual
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Provider Name | ALLANTE R'REALE BURNELL LLP
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Gender | Female
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Dates
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Enumeration Date | 04/26/2016
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Last Update Date | 07/30/2021
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Provider Practice Location Address
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Address Line | 28175 HAGGERTY RD
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City | NOVI
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State | MI
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Zip | 48377-2903
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Country | US
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Telephone | 734-489-1615
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Fax |
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Provider Business Mailing Address
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Address Line | 28175 HAGGERTY RD
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City | NOVI
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State | MI
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Zip | 48377-2903
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Country | US
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Telephone | 734-489-1615
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 6361007624
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301017432
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License Number State | MI
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