MEDICARE: INSIGHT PSYCHOLOGY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1174222046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSIGHT PSYCHOLOGY PLLC

Provider Business Mailing Address
First Line	:	29488 WOODWARD AVE # 361
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-0903
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	517 WOODCREST DR
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-2232
Country	:	US
Telephone Number	:	248-609-3183
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST/OWNER
Name	:	AMANDA BODE DAVIDSON
Credential	:	LLP
Telephone Number	:	248-609-3183

Provider Enumeration Date	:	02/28/2023
Last Update Date	:	02/28/2023

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