Basic Information
Provider Information
NPI: 1326140427
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MINGO
FirstName: MARGARET
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: MA NCC LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 29724 ELEVEN MILE RD
Address2:  
City: FARMINGTON HILLS
State: MI
PostalCode: 48336
CountryCode: US
TelephoneNumber: 2484771192
FaxNumber:  
Practice Location
Address1: 9315 TELEGRAPH
Address2:  
City: REDFORD
State: MI
PostalCode: 48239
CountryCode: US
TelephoneNumber: 3134504500
FaxNumber: 3134504500
Other Information
ProviderEnumerationDate: 09/01/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC1900X6401008937MIY Behavioral Health & Social Service ProvidersPsychologistCounseling

No ID Information.


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