Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 6301010218 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301010218 | MI |
NPI | 1013139757 |
---|---|
Provider Name | Dr. Karen Klein Villa |
First Address | Brighton, MI 48116-2479 |
Second Address | Brighton, MI 48116-2479 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 07/03/2017 |