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General NPI Number Information
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NPI Number | 1972624716
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Entity Type | Individual
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Provider Name | DENISE F MANSOUR PSY.D., LLP, CTS
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Gender | Female
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 12/27/2022
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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 | 734-265-0841
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Fax |
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Provider Business Mailing Address
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Address Line | 109 HIGHLAND DR
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48302-0358
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Country | US
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Telephone | 248-202-4192
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301013014
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6361003557
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License Number State | MI
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