MEDICARE: INTEGRATED ENTERPRISES,P.C.

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	101YP2500X	Professional Counselor	6401005154	MI
2	103G00000X	Clinical Neuropsychologist	6301008104	MI
3	103TA0700X	Adult Development & Aging Psychologist	6301008104	MI
4	103TC0700X	Clinical Psychologist	6301008104	MI
5	103T00000X	Psychologist	6301008104	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11643507	OTHER	MI	CAQH
2	1558441840	OTHER	MI	NPI

General Provider Information

NPI Number	:	1760545065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED ENTERPRISES,P.C.

Provider Business Mailing Address
First Line	:	30445 NORTHWESTERN HWY
Second Line	:	SUITE 240
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-3158
Country	:	US
Telephone Number	:	248-538-5045
Fax Number	:

Provider Business Practice Location Address
First Line	:	30445 NORTHWESTERN HWY
Second Line	:	SUITE 240
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-3158
Country	:	US
Telephone Number	:	248-538-5045
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. HARRIET J. MALL
Credential	:	PH.D.
Telephone Number	:	248-538-5045

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	09/11/2025

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48334-3158

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1225260763 — MARCIA B. STEIN M.S.W.
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Directions to “INTEGRATED ENTERPRISES,P.C. ” Practice Location

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