Individual
JESSICA RANAE BEATTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LP
Contact information
Practice address
35980 WOODWARD AVE STE 100, BLOOMFIELD HILLS, MI 48304-0903
(248) 220-3332
(248) 462-6963
Mailing address
35980 WOODWARD AVE STE 100, BLOOMFIELD HILLS, MI 48304-0903
(248) 220-3332
(248) 462-6963
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301014373
MI
390200000X
Student in an Organized Health Care Education/Training Program
6301013682
MI
Other
Enumeration date
09/10/2008
Last updated
07/08/2022
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