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General NPI Number Information
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NPI Number | 1700477924
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Entity Type | Individual
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Provider Name | TALIB KAFAJI LP
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Gender | Male
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Dates
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Enumeration Date | 01/30/2021
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 6960 ORCHARD LAKE RD STE 202
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-4519
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Country | US
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Telephone | 248-985-9942
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Fax |
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Provider Business Mailing Address
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Address Line | 41800 W 11 MILE RD STE 110
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City | NOVI
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State | MI
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Zip | 48375-1818
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Country | US
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Telephone | 472-191-2839
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Fax | 248-513-3144
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301007149
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License Number State | MI
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