=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497649289
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OUTCOME FACILITATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2025
-----------------------------------------------------
Last Update Date | 08/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5083 BUCKLEY DR
-----------------------------------------------------
City | YPSILANTI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48197-6815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-395-0606
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5083 BUCKLEY DR
-----------------------------------------------------
City | YPSILANTI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48197-6815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-395-0606
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LAURA HIGLE
-----------------------------------------------------
Credential | LLP
-----------------------------------------------------
Telephone | 734-395-0606
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------