Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0004X | Health Psychologist | 6301017391 | MI |
NPI | 1417454448 |
---|---|
Provider Name | Kayla Ferguson Trombley |
First Address | Oxford, MI 48371-5707 |
Second Address | Troy, MI 48084-4400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2018 |
Last Update Date | 06/04/2018 |