Doctor Name: | MRS. EDNA CHANG |
NPI Number: | 1093146433 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LLP |
License Number: | 6301014328 |
Business Practice Address: | 45670 White Oak Dr Shelby Township, MI - 483156035 |
Business Phone Number: | 5865668456 |
Business Fax Number: | |
Mailing Address: | 45670 White Oak Dr, SHELBY TOWNSHIP |
State: | MI |
Postal Code: | 483156035 |
Phone Number: | 5865668456 |
Fax Number: | |
NPI Enumeration Date: | 12/11/2013 |
NPI Last Update Date: | 12/11/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 6301014328 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |