Individual
SCOTT MACINNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
905 S CENTER ST, ROYAL OAK, MI 48067-3230
(313) 477-9403
Mailing address
46540 BARTLETT DR, CANTON, MI 48187-1517
(313) 477-9403
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6361007539
MI
247200000X
Other Technician
—
—
Other
Enumeration date
04/05/2016
Last updated
09/14/2021
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