Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 822164 | MI |
Y | 103G00000X | Clinical Psychologist | 6301007666 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301007666 | MI |
NPI | 1013072164 |
---|---|
Provider Name | Ray Kamoo |
First Address | Bingham Farms, MI 48025-5711 |
Second Address | Bingham Farms, MI 48025-5711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 11/06/2021 |