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General NPI Number Information
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NPI Number | 1487412490
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Entity Type | Organization
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Legal Business Name | INTEGRATED MENTAL HEALTH PROFESSIONALS, PLLC
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Dates
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Enumeration Date | 03/13/2024
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Last Update Date | 03/14/2024
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Provider Practice Location Address
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Address Line | 3477 FOX WOODS CT
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48324-3266
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Country | US
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Telephone | 248-410-4793
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 252563 6725 DALY RD
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-8777
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Country | US
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Telephone | 248-410-4793
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. MICHELLE VICTORIA
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Credential | PHD
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Telephone | 248-410-4793
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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