Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 6301011759 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301011759 | MI |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 6301011759 | MI |
NPI | 1134384274 |
---|---|
Provider Name | Dr. Rosalynn Marie Moten |
First Address | Troy, MI 48084-3919 |
Second Address | Troy, MI 48084-3919 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2008 |
Last Update Date | 22/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
M80840 | PSYCHOLOGIST (01) | MI |