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General NPI Number Information
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NPI Number | 1558704395
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Entity Type | Individual
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Provider Name | RENEE LYNN STROTHMAN PETKOVICH TLLP
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Gender | Female
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Dates
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Enumeration Date | 04/11/2013
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 110 GLENDALE CT
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City | MONROE
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State | MI
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Zip | 48162-2605
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Country | US
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Telephone | 734-790-0701
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Fax |
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Provider Business Mailing Address
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Address Line | 19805 FARMINGTON RD
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City | LIVONIA
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State | MI
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Zip | 48152-1444
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 6361007547
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License Number State | MI
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