Provider Demographics
NPI:1053022368
Name:RATHI, JYOTI (PHD, LLP)
Entity type:Individual
Prefix:
First Name:JYOTI
Middle Name:
Last Name:RATHI
Suffix:
Gender:F
Credentials:PHD, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 S LAPEER RD STE 175N
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1467
Mailing Address - Country:US
Mailing Address - Phone:248-393-5555
Mailing Address - Fax:
Practice Address - Street 1:1455 S LAPEER RD STE 175N
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1467
Practice Address - Country:US
Practice Address - Phone:248-393-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6351004572103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical