Provider Demographics
NPI:1104242429
Name:LAUREL A. SILLS, PSY.D., PLLC
Entity type:Organization
Organization Name:LAUREL A. SILLS, PSY.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SILLS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:248-788-4230
Mailing Address - Street 1:7182 HUNTCLIFF
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2938
Mailing Address - Country:US
Mailing Address - Phone:248-788-4230
Mailing Address - Fax:
Practice Address - Street 1:31313 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 120
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2559
Practice Address - Country:US
Practice Address - Phone:248-788-4230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006969103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty