MEDICARE: HOPEFUL MINDS PSYCHOLOGY GROUP LLC

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	:	1467150706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPEFUL MINDS PSYCHOLOGY GROUP LLC

Provider Business Mailing Address
First Line	:	13330 SEQUOIA LN
Second Line	:
City	:	SOUTH LYON
State	:	MI
Zip	:	48178-9112
Country	:	US
Telephone Number	:	248-795-9445
Fax Number	:

Provider Business Practice Location Address
First Line	:	13330 SEQUOIA LN
Second Line	:
City	:	SOUTH LYON
State	:	MI
Zip	:	48178-9112
Country	:	US
Telephone Number	:	248-795-9445
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOSHUA J MURRAY
Credential	:	MA LLP
Telephone Number	:	248-795-9445

Provider Enumeration Date	:	02/16/2023
Last Update Date	:	02/16/2023

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