Individual
MR. MARK LEE BLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
700 STEWART RD, STE 105, MONROE, MI 48162-5304
(734) 240-1765
(734) 240-1787
Mailing address
718 N MACOMB ST, MONROE, MI 48162-7815
(734) 240-8400
(734) 240-4450
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301014288
MI
Other
Enumeration date
08/11/2011
Last updated
08/11/2011
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