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General NPI Number Information
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NPI Number | 1821327222
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Entity Type | Organization
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Legal Business Name | AMY J. TRABITZ, PH.D., P.C.
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Dates
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Enumeration Date | 12/14/2009
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Last Update Date | 10/08/2013
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Provider Practice Location Address
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Address Line | 23810 MICHIGAN AVE SUITE 202B
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City | DEARBORN
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State | MI
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Zip | 48124-1830
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Country | US
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Telephone | 313-359-3161
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Fax | 313-359-4811
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Provider Business Mailing Address
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Address Line | 23810 MICHIGAN AVE SUITE 202B
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City | DEARBORN
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State | MI
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Zip | 48124-1830
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Country | US
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Telephone | 313-359-3161
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Fax | 313-359-4811
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AMY J. TRABITZ
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Credential | PH.D.
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Telephone | 313-359-3161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 6301006103
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 6301006103
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License Number State | MI
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