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General NPI Number Information
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NPI Number | 1366989584
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Entity Type | Organization
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Legal Business Name | NEURO WELLNESS INSTITUTE PC
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Dates
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Enumeration Date | 01/25/2017
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Last Update Date | 02/03/2020
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Provider Practice Location Address
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Address Line | 2073 E MAPLE RD
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City | TROY
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State | MI
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Zip | 48083-4493
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Country | US
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Telephone | 519-490-8920
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Fax |
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Provider Business Mailing Address
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Address Line | 2073 E MAPLE RD
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City | TROY
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State | MI
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Zip | 48083-4493
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Country | US
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Telephone | 226-260-1181
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Fax | 313-666-0178
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Authorized Official
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Title or Position | CEO
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Name | DR. HUILAN ZHANG
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Credential | PSYD
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Telephone | 226-260-1181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301014375
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License Number State | MI
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