Provider Demographics
NPI:1518402247
Name:SPENCE, MARY FRANCES (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:FRANCES
Last Name:SPENCE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 FOX POINTE CIR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-8940
Mailing Address - Country:US
Mailing Address - Phone:734-754-0468
Mailing Address - Fax:
Practice Address - Street 1:204 W GRAND RIVER AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-2299
Practice Address - Country:US
Practice Address - Phone:517-540-6166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005848103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical