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Organization

EMOTIONAL FITNESS CENTER PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
M. LYNN VAUGHN PHD (OWNER)
(248) 921-7922
Entity
Organization

Contact information

Practice address
2440 SHAWOOD ST, NOVI, MI 48377-1970
(248) 921-7922
Mailing address
2440 SHAWOOD ST, NOVI, MI 48377-1970
(248) 921-7922

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301006411
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1346292794
IND NPI
MI
01
6301006411
LIC #
MI
01
680F38144
BLUE CROSS
MI
Enumeration date
05/02/2013
Last updated
05/02/2013
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