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General NPI Number Information
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NPI Number | 1346989365
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Entity Type | Individual
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Provider Name | SARA ANN TEMPLE MA, TLLP
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Gender | Female
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Dates
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Enumeration Date | 05/27/2022
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Last Update Date | 05/27/2022
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Provider Practice Location Address
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Address Line | 4800 GRAND RIVER AVE
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City | DETROIT
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State | MI
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Zip | 48208-2252
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Country | US
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Telephone | 734-335-0568
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Fax |
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Provider Business Mailing Address
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Address Line | 1540 W BOSTON BLVD
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City | DETROIT
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State | MI
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Zip | 48206-1707
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Country | US
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Telephone | 734-664-9907
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 6362009419
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License Number State | MI
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