MEDICARE: MR. NORRIS D. MCCRARY MA,LLP,CAC-1

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	103T00000X	Psychologist	6301006801	MI

General Provider Information

NPI Number	:	1730193624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NORRIS D. MCCRARY MA,LLP,CAC-1

Provider Business Mailing Address
First Line	:	29735 WEXFORD BLVD
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48377-4400
Country	:	US
Telephone Number	:	248-310-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	8623 N WAYNE RD
Second Line	:	SUITE 310
City	:	WESTLAND
State	:	MI
Zip	:	48185-1137
Country	:	US
Telephone Number	:	734-425-0636
Fax Number	:	734-425-4771

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/08/2007

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