Provider Demographics
NPI:1245560713
Name:AKHTER, KOMAL (LLP)
Entity Type:Individual
Prefix:MS
First Name:KOMAL
Middle Name:
Last Name:AKHTER
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:KOMAL
Other - Middle Name:
Other - Last Name:NISAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35560 GRAND RIVER
Mailing Address - Street 2:PMB# 224
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335
Mailing Address - Country:US
Mailing Address - Phone:248-871-7551
Mailing Address - Fax:
Practice Address - Street 1:41700 GARDENBROOK RD
Practice Address - Street 2:GARDEN OFFICE B SUITE 110
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375
Practice Address - Country:US
Practice Address - Phone:800-693-1916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361000180103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist