Basic Information
| Provider Information | |||||||||
| NPI: | 1700255585 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | FELICIA | ||||||||
| MiddleName: | MICHIKO | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | TLLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 739 BRIDGE AVE | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | ONTARIO | ||||||||
| PostalCode: | N9B2M5 | ||||||||
| CountryCode: | CA | ||||||||
| TelephoneNumber: | 2263457597 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 79 W ALEXANDRINE ST | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138315535 | ||||||||
| FaxNumber: | 3138312608 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2015 | ||||||||
| LastUpdateDate: | 04/13/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 6301016392 | MI | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.