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General NPI Number Information
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NPI Number | 1841129038
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Entity Type | Organization
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Legal Business Name | PHOENIX MIND PSYCHOLOGY PLLC
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Dates
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Enumeration Date | 05/15/2026
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Last Update Date | 05/15/2026
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Provider Practice Location Address
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Address Line | 10500 SOUTHERN ST
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City | DEARBORN
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State | MI
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Zip | 48126-3721
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Country | US
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Telephone | 313-242-7162
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Fax |
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Provider Business Mailing Address
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Address Line | 30 BLAIR LN
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City | DEARBORN
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State | MI
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Zip | 48120-1301
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Country | US
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Telephone | 313-573-3758
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ZEINA ANGELA YAHFOUFI
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Credential | LLP
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Telephone | 313-242-7162
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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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