Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 6301013227 | MI |
Y | 103T00000X | Psychologist | 6301013227 | MI |
NPI | 1013200922 |
---|---|
Provider Name | Cherie Beba |
First Address | Sterling Heights, MI 48310-6943 |
Second Address | Rochester Hills, MI 48307-2267 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2011 |
Last Update Date | 25/05/2011 |