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General NPI Number Information
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NPI Number | 1275876963
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Entity Type | Individual
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Provider Name | ALFRED MANSOUR PHD
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Gender | Male
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Dates
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Enumeration Date | 04/01/2013
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Last Update Date | 08/09/2018
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Provider Practice Location Address
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Address Line | 5333 MCAULEY DR
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City | YPSILANTI
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State | MI
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Zip | 48197
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Country | US
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Telephone | 734-712-4162
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Fax | 734-712-5056
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Provider Business Mailing Address
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Address Line | 5333 MCAULEY DR
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City | YPSILANTI
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State | MI
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Zip | 48197-1014
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Country | US
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Telephone | 734-712-4162
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Fax | 734-712-5056
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 6301014783
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 6301014783
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301016060
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License Number State | MI
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