Provider Demographics
NPI:1104001486
Name:BERRY, YVONNE LOUISE (MALLPC)
Entity Type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:LOUISE
Last Name:BERRY
Suffix:
Gender:F
Credentials:MALLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13101 ALLEN RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2216
Mailing Address - Country:US
Mailing Address - Phone:734-785-7705
Mailing Address - Fax:734-785-7734
Practice Address - Street 1:13101 ALLEN RD
Practice Address - Street 2:SUITE 400
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2216
Practice Address - Country:US
Practice Address - Phone:734-785-7705
Practice Address - Fax:734-785-7734
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009699101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional