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General NPI Number Information
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NPI Number | 1689361693
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Entity Type | Organization
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Legal Business Name | MARY THERAPY CENTER, PLLC
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Dates
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Enumeration Date | 04/19/2023
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Last Update Date | 10/19/2023
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Provider Practice Location Address
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Address Line | 28175 HAGGERTY RD
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City | NOVI
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State | MI
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Zip | 48377-2903
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Country | US
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Telephone | 248-755-2535
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Fax |
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Provider Business Mailing Address
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Address Line | 28175 HAGGERTY RD
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City | NOVI
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State | MI
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Zip | 48377-2903
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Country | US
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Telephone | 248-755-2535
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINE MARY
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Credential | MA, LLP
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Telephone | 248-755-2535
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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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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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