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General NPI Number Information
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NPI Number | 1447706213
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Entity Type | Organization
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Legal Business Name | MYBODY, PLLC
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 912 S OLD WOODWARD AVE STE 200
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City | BIRMINGHAM
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State | MI
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Zip | 48009-6721
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Country | US
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Telephone | 248-537-2639
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Fax |
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Provider Business Mailing Address
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Address Line | 912 S OLD WOODWARD AVE STE 200
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City | BIRMINGHAM
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State | MI
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Zip | 48009-6721
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Country | US
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Telephone | 248-537-2639
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | VALERIE LUXON
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Credential | PSY.D
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Telephone | 248-791-2639
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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 | 6301016242
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License Number State | MI
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