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Individual

FATEN Y BAZZI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS, LLP

Contact information

Practice address
363 W BIG BEAVER RD STE 315, TROY, MI 48084-5242
(248) 354-8460
Mailing address
3710 EASTHAM RD, DEARBORN, MI 48120-1049
(313) 505-0594

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
6301014548
MI
103TC0700X
Clinical Psychologist
Primary
6361007094
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3434247
MI
Enumeration date
11/10/2010
Last updated
10/27/2021
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