Provider Demographics
NPI:1679724256
Name:RUHL, MICHAELENE RENEE (PSYD, LLP)
Entity type:Individual
Prefix:DR
First Name:MICHAELENE
Middle Name:RENEE
Last Name:RUHL
Suffix:
Gender:F
Credentials:PSYD, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30794 LAMAR ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2639
Mailing Address - Country:US
Mailing Address - Phone:248-345-3557
Mailing Address - Fax:
Practice Address - Street 1:33335 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-3194
Practice Address - Country:US
Practice Address - Phone:248-821-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2013-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015641103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical