Basic Information
| Provider Information | |||||||||
| NPI: | 1346679289 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORELL | ||||||||
| FirstName: | IMAGENE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1410 S TELEGRAPH RD | ||||||||
| Address2: | |||||||||
| City: | BLOOMFIELD HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483020046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484568150 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1063 PROFESSIONAL DR | ||||||||
| Address2: | SUIT D-4 | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8104964935 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2013 | ||||||||
| LastUpdateDate: | 11/01/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6401013727 | MI | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | 6401013727 | MI | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 6401013727 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.