Provider Demographics
NPI:1134513708
Name:GURA-PALIAROLI, VICKY
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:
Last Name:GURA-PALIAROLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VICKY
Other - Middle Name:
Other - Last Name:GURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:13918 IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-4299
Mailing Address - Country:US
Mailing Address - Phone:586-321-9829
Mailing Address - Fax:
Practice Address - Street 1:1025 E MAPLE RD
Practice Address - Street 2:SUITE B-4
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6426
Practice Address - Country:US
Practice Address - Phone:248-686-3347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801091588101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health