Provider Demographics
NPI:1487412490
Name:INTEGRATED MENTAL HEALTH PROFESSIONALS, PLLC
Entity type:Organization
Organization Name:INTEGRATED MENTAL HEALTH PROFESSIONALS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:VICTORIA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-410-4793
Mailing Address - Street 1:PO BOX 252563
Mailing Address - Street 2:6725 DALY RD
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-8777
Mailing Address - Country:US
Mailing Address - Phone:248-410-4793
Mailing Address - Fax:
Practice Address - Street 1:3477 FOX WOODS CT
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324-3266
Practice Address - Country:US
Practice Address - Phone:248-410-4793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-13
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty