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General NPI Number Information
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NPI Number | 1700503984
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Entity Type | Organization
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Legal Business Name | MIRA CELY, PH.D., PLLC
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Dates
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Enumeration Date | 10/27/2022
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Last Update Date | 10/27/2022
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Provider Practice Location Address
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Address Line | 300 E MAPLE RD STE 322
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City | BIRMINGHAM
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State | MI
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Zip | 48009-6311
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Country | US
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Telephone | 248-342-8566
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Fax |
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Provider Business Mailing Address
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Address Line | 29968 SPARKLEBERRY DR
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2072
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Country | US
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Telephone | 248-342-8566
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MIRA CELY
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Credential | PH.D., L.P.
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Telephone | 248-342-8566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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