Basic Information
| Provider Information | |||||||||
| NPI: | 1841815289 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GHAZI | ||||||||
| FirstName: | JAMAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7350 AMBOY ST | ||||||||
| Address2: | |||||||||
| City: | DEARBORN HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481271636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138174562 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8623 N WAYNE RD STE 107 | ||||||||
| Address2: | |||||||||
| City: | WESTLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481851137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344584601 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2020 | ||||||||
| LastUpdateDate: | 06/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TS0200X | Y | Behavioral Health & Social Service Providers | Psychologist | School |
No ID Information.