MEDICARE: DR. NATALIE BROHL PERELLI PH.D.

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	103TC1900X	Counseling Psychologist	6301012759	MI

General Provider Information

NPI Number	:	1568492411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATALIE BROHL PERELLI PH.D.

Provider Business Mailing Address
First Line	:	45227 PINETREE DR
Second Line	:
City	:	PLYMOUTH
State	:	MI
Zip	:	48170-3842
Country	:	US
Telephone Number	:	734-451-7487
Fax Number	:

Provider Business Practice Location Address
First Line	:	6223 N CANTON CENTER RD
Second Line	:	SUITE 210
City	:	CANTON
State	:	MI
Zip	:	48187-2696
Country	:	US
Telephone Number	:	734-737-1200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	07/08/2007

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