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General NPI Number Information
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NPI Number | 1467114728
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Entity Type | Organization
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Legal Business Name | SERENITY PSYCHOLOGICAL SERVICES PC
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Dates
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Enumeration Date | 10/13/2021
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Last Update Date | 01/28/2022
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Provider Practice Location Address
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Address Line | 29551 GREENFIELD RD STE 216
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City | SOUTHFIELD
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State | MI
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Zip | 48076-5872
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Country | US
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Telephone | 248-906-9191
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Fax |
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Provider Business Mailing Address
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Address Line | 14301 HOPE DR
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City | STERLING HEIGHTS
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State | MI
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Zip | 48313-3550
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | MARYBETH HOUPT
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Credential |
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Telephone | 517-676-9788
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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 |
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License Number State |
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