Provider Demographics
NPI:1992919112
Name:THOMAS - CHEATHAM, MICHELLE YVETTE (MS LLP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:YVETTE
Last Name:THOMAS - CHEATHAM
Suffix:
Gender:F
Credentials:MS LLP
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:YEVETTE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS LLP
Mailing Address - Street 1:512 FOX HILLS DR S
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-1316
Mailing Address - Country:US
Mailing Address - Phone:248-506-4437
Mailing Address - Fax:
Practice Address - Street 1:30150 TELEGRAPH RD STE 245
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4521
Practice Address - Country:US
Practice Address - Phone:248-453-7525
Practice Address - Fax:248-605-3525
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361003060103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist